Sluggish schizophrenia: causes, how it manifests itself and is treated. Sluggish schizophrenia Symptoms of sluggish

Psychiatrists never rush to diagnose schizophrenia. It can be equated with a sentence. Therefore, it is necessary to know 7 symptoms and signs of sluggish schizophrenia in order to contact a competent specialist for help in a timely manner.

Causes

Currently, the causes of schizophrenia have not been established. Scientists only put forward their assumptions. Therefore, this disease is considered multifactorial.

The first factor is based on genetics. For example, if the parents are suffering from schizophrenia at the birth of a child, then the risk of transmission is fifty to fifty. If only one of the parents is sick, then the chance of transmission of the (congenital) disease drops sharply to almost twelve percent. This indicates the emergence of a predisposition to the disease. The predisposition does not apply to diseases. Pathology may appear after a certain period of time. This time is influenced by factors such as:

Parents' health.
The use of drugs.
Drinking alcoholic beverages and many other factors.

The second group is biochemical. It is based on the fact that its factors, in the process of illness, can cause another illness, which is called psychosis.

The main signs

If you start this disease, then it is almost impossible to cure it. Currently, there is one opinion that schizophrenia has initial symptoms in the form of hallucinations. But in fact, they can manifest themselves in various forms:

Disturbance in the system of emotions.
A sharp change in vital interests.
The emergence of fears and so on.

The 7 signs of sluggish schizophrenia include:

A gradual decrease in physical and intellectual activity.
Closure in oneself.
Mood swings.
Violation of the perception of the external and internal worlds.
There is no logic.
Belief in unreal things.
Deception of perception.

Symptom groups

As a result of the above, all the symptoms of sluggish schizophrenia can be divided into two groups:

Productive factors.
Negative factors.

The most problematic are precisely the negative factors. This group is based on such problems as lack of emotion when experiencing extreme situations and interruption in thinking. Some psychologists are able to identify schizophrenia even after communicating with the patient. This diagnosis will be prompted by violations in speech and thinking.

How quickly can a disease be identified?

If in the family in which the child grew up, there were constant scandals or conflicts of some kind, then the cause of schizophrenia may even be, for example, the loss of a job. Symptoms of sluggish schizophrenia appear several days after the incident. The first sign is an instantaneous change in a person's behavior.

Stages

The course of sluggish schizophrenia occurs in stages. The following stages are distinguished:

The debut (or latent stage) - has blurred and dim symptoms, and therefore the course may remain unnoticed even by the patient's closest people. The following manifestations are characteristic:

persistent affects;
prolonged hypomania;
somatized depression.

This stage often occurs during puberty. Among adolescents, attempts to avoid communication, refusals to leave the house are possible.

Views

If we take into account the stage of the disease, as well as some of its manifestations, then two types of sluggish schizophrenia can be distinguished.

Neurosis-like.
Psychopathic.

The difference between these two types is that phobic disorders are more characteristic of the neurosis-like type. They are manifested in obsessive fears caused by a variety of factors, and often generally unreasonable. This is especially often manifested in the fear of being in society and the desire to constantly be at home. Such patients are very afraid of various infections, therefore, most often they isolate themselves from any society. The process itself occurs gradually and often unnoticed by others and the patient himself.

In another type of sluggish schizophrenia - psychopathic - the most striking symptom is not fear, but depression - that is, a stable negative emotional background over a long period of time, as well as the gradually developing depersonalization of his personality. This whole set of symptoms is usually called the flattening of affect. The patient ceases to strive to contact other people, he looks at himself as if from the outside, constantly evaluating his actions and talking to himself. He ceases to be aware of himself as the person he is. This, for example, manifests itself in the fact that he ceases to recognize his reflection in the mirror, proving that this is a completely different person.

Often the theory of substitution of a person appears in this issue. Such people do not have any emotional reaction to the surrounding situation, and over time they begin to lead an almost emotionally vegetable lifestyle. Also, this species may be characterized by a craving for vagrancy and gathering, a particularly strong love for animals, with which such people seek to replace their need for contact with people.

Diagnostics

Diagnosing a sluggish type of schizophrenia is a very difficult task, which often requires very lengthy follow-up, which can drag on indefinitely. And even in this case, one should not rush to the final diagnosis.

There are two types of deviations from which it is difficult to distinguish sluggish schizophrenia: borderline states - various types of psychopathy, neurotic deviations and similar diseases. Manifestations of progressive schizophrenia (neurosis-like and psychopathic) are also possible. As already mentioned, the disease is very difficult to diagnose. If it is impossible to make an undeniable diagnosis in this situation, then it is better to give preference to something that is different from this disease, and start treating the patient without stopping observation of him. There were cases when a patient was treated for neurosis for 4-8 years and only after their lapse he received a diagnosis of "sluggish schizophrenia".

The same applies to doubts in differential diagnosis with other types of schizophrenia. In this case, it is better to give preference to other types of this disease and apply the necessary treatment methods.

Treatment

The goal of treatment for the diagnosis of sluggish schizophrenia is to achieve a stable remission, with constant maintenance therapy. Treatment consists in taking medications. The medication prescribed by the doctor should be taken regularly. Only with strict adherence to the treatment regimen is it possible to achieve positive results. The following types of drug treatment are distinguished:

Traditional antipsychotics.

The action is carried out by blocking dopamine receptors. The choice of drug is based on the patient's condition, the level of severity of side effects, and also depends on the route of administration. These drugs include the following drugs: Haloperidol, Chlorpromazine, Thiothixen, etc.

Second generation antipsychotics.

They affect the activity of dopamine and serotonin receptors. The advantage of these agents is that they have fewer side effects. The highest efficiency in relation to the symptoms of the disease remains an open question. These include drugs: "Olanzapine", "Ziprasidone", "Risperidone", "Aripiprazole" and others. When taking this group of drugs, it becomes necessary to control the patient's body weight, as well as to track the appearance of signs of type 2 diabetes.

Social support

In addition to the implementation of drug therapy, there is a great need for sick people to provide support of a social nature. Be sure to attend various trainings and programs, the tasks of which are aimed at rehabilitation. Such activities allow patients to:

provide self-care for yourself;
feel comfortable in society;
continue working.

Collaboration

In the treatment of sluggish schizophrenia, an integrated approach is very important. The help of a psychologist, psychotherapist and social workers is required. Also, close people should provide proper support, not ignoring the patient's problems. Hospitalization may be necessary at the onset of the disease. Do not neglect this doctor's appointment. Involvement in creativity, attending various sessions of art therapy and cultural places also has a beneficial effect on the condition of patients. It is not recommended to hinder the patient's self-realization if he shows interest in creativity. One should not hide a person with a disease from society or be ashamed of him.

Features of sluggish schizophrenia in women and men

Today, medicine knows the main features of schizophrenia, which are the same in both men and women.

Reducing the emotionality of a person and the appearance of indifference to the world around him.
The desire in any way to close off from the people around and isolate oneself from the world.
Indifference to their former interests and focusing on only one narrow area.
Inability to adapt to the outside world and to its changes.

Sluggish schizophrenia in men greatly reduces the emotional response to events or phenomena occurring in their lives.

In some cases, a person may begin to carry completely incoherent delusions or will see hallucinations. There are also significant increases in speech, speech becomes incoherent and illogical.

Symptoms of sluggish schizophrenia in women are similar to those in men, but there are some other characteristics. A patient with schizophrenia may experience a quick change of mood to the opposite, as well as a desire to bring absolutely unnecessary things to his home. There has also been a dramatic shift in clothing and makeup choices. A woman can use very bright makeup or, on the contrary, become unkempt.

Sluggish (low-grade) schizophrenia is divided into three types - psychopathic schizophrenia, simple and neurosis-like schizophrenia, and is classified as a transitional form. This means that she does not express with all certainty the signs of schizophrenia, but has only individual symptoms, partially in contact with the disease. It is expressed by asthenic, obsessive-phobic, hypochondriacal, paranoid disorders and is defined as a benign form of schizophrenia.

If classical schizophrenia is characterized by deep degradation of the personality, then the sluggish one carries only a deformation of the essence of the personality (change in behavior, range of interests, motives) and develops slowly, for decades, with a gradual deepening of deficient personality traits. In some cases, the disease resembles a lingering neurosis, in others - psychopathy, that is, a combination of symptoms from different syndromes. This pathology can be provoked by various psychotraumas, improper lifestyle and stress, and recovery is possible even without treatment. In the international classification of diseases (ICD-10), such a diagnosis of "sluggish schizophrenia" is absent; many authors use this concept as a synonym for schizotypal disorder.

Sluggish schizophrenia and gender

The gender of patients is not a factor that significantly affects the typology of the course of the schizophrenic process. The risk of disease in men and women is approximately the same, but women tend to have a later onset of the disease and faster recovery than men. The main difference from the fact that women are more likely to have a paroxysmal form, and men are more prone to a continuous form. Usually, the symptoms in men are more pronounced, the external signs of the disease are more noticeable: untidy appearance, unwillingness to take care of oneself. At the same time, if such symptoms occur in women, those around them immediately notice them, although it is impossible to say at what stage of the disease these manifestations of the disease become noticeable.

Neurosis-like schizophrenia

This form of schizophrenia is considered the most favorable, as it has a large number of persistent remissions. It includes a wide range of anxious-phobic obsessions and usually begins in adolescence, while a shallow personality defect of the type of mental infantilism is formed. It was noticed that the later the process begins, the softer it proceeds.

The most pronounced symptoms are dysmorphomania, panic attacks, derealization, depersonalization, obsessions may be present, which differ from neurotic disorders in greater insurmountability. If with neuroses, patients hide their rituals from others, then with neurosis-like schizophrenia, rituals are performed openly, and patients may even involve others in them. These rituals are protective, relieve nervous tension and, according to the patient, prevent trouble. They are very complex, sometimes last for hours and gradually take a leading position in the clinical picture, completely displacing other human actions, that is, he cannot take a step until he has performed a lot of rituals, which can sometimes lead to complete isolation from society.

Phobias, which can be especially strange, are colored with less emotionality, but, nevertheless, can lead to suicide. The patient spends all the time at home, and even there he does not feel completely safe.

Hypochondriacal sluggish schizophrenia

Hypochondriacal sluggish schizophrenia is expressed by an obsessive fear of having some kind of disease (most often cancer), with an exaggerated assessment of its consequences, despite the negative results of a medical examination. Its main core is made up of ideas and thoughts associated with pathological, unusual sensations that arise in their own body. The patient can feel certain somatic ailments in the body, or assert that there is some creature in his body, for example, a worm, and colorfully describe the movements of the animal in himself. The queues in polyclinics are 60% of these people. They believe that the doctors made a mistake in the diagnosis, and are firmly convinced that they are sick with a serious, incurable disease, although they cannot accurately convey their painful sensations in words. Such patients, as a rule, use metaphorical comparisons: “the heart burns,” “a fire is burning in the stomach,” “pus fills the whole body,” etc.

Latent schizophrenia

A number of researchers attribute latent schizophrenia, expressed by mild disorders, to latent forms of sluggish schizophrenia, its existence is not recognized by all authors and is actively disputed by them. Psychotic symptoms are usually not observed with it, but over time they can manifest themselves under the influence of various adverse factors. Personality change is pronouncedly weak, the behavior and priorities of patients do not change much, mental disorders are minimal.

Signs of sluggish schizophrenia

Sluggish schizophrenia has various symptoms, one of which is alienation. The patient is completely immersed in himself and constantly listens to the processes taking place in his body, is engaged in self-digging. In this case, the impoverishment of his mental abilities occurs, activity and initiative disappear, and there is a detached perception of reality. The patient has an increased interest in abstract, abstract problems (magic, religion, problems of the universe), he often studies a lot of philosophical literature (philosophical intoxication). The volitional sphere also suffers, a person rushes between opposite decisions and, as a result, completely refuses any choice. The attitude towards relatives changes noticeably, the person becomes indifferent to their needs, the ability to empathize disappears. Demonstration, flirtatiousness, cutesy and hysterical notes that were unusual before may appear. Gradually, his appearance takes on eccentric features, sloppiness appears, which causes ridicule and rejection of others. His speech becomes pompous, meaningful, but at the same time poor in intonation.

The main symptoms (obsessions, phobias, overvalued ideas) dominate throughout the disease. The course of the disease is uneven, at first the symptomatology develops rather quickly, then the course slows down and is accompanied by either recessions or rises in mental disorders. Occasionally, fragmentary delusional ideas, hallucinations and individual psychic automatisms can arise. Patients are most often socially adapted, they can have families and friendships, although their mental disorders are noticeable even to a non-specialist. To relieve symptoms, such people may start using alcohol and drugs, in which case a practically irreversible personality defect quickly sets in.

Treatment of indolent schizophrenia

Treatment of patients with a diagnosis of low-grade schizophrenia, especially with a predominance of hysterical and neurosis-like disorders, should include a course of psychotherapy, which carries a purposeful and sometimes painful work on itself. A person needs to learn to take responsibility for his life and understand that he has the opportunity to choose, that he is not a helpless victim of the disease, his future depends only on himself and positive changes are possible. You cannot instill in a person that he must learn to live with his symptoms, that his illness is chronic and focus his attention on this. It can take a long time to recover, since change and self-knowledge is an internal process, and it cannot be artificially accelerated, because the acquired painful manifestations are firmly held in the structure of the personality.

In some cases, psychotropic drugs are used. Treatment of sluggish schizophrenia with this technique is determined by the course of the disease process, and the use of drugs reduces emotional stress, eliminates hysterical and phobic reactions. After several years of active therapy, the complete disappearance of psychopathological manifestations is possible.

Patients with schizophrenia who are in the process of successful treatment can sometimes experience emotional complications that cause the disease to relapse. To prevent relapse, it is important to recognize early warning signs of danger (for example, nightmares) and stop them in time, which does not require tough measures. The patient's consciousness must be taken away from the unconscious by simple therapeutic methods. You can offer the patient to draw a picture of his internal state, as a result of which the whole chaos is objectified and can already be considered detached. Such a picture diminishes the meaning of horror, makes it tame, commonplace, removes the reminder of the original experience and allows the patient to explore and interpret it consciously.

Relatives are often interested in how to deal with a person with schizophrenia. First, the healthy parts of the personality should be addressed and maintained. You should not treat the patient as a dangerous, uncontrollable person, because he needs increased attention, care and patience, and the favorable climate at home has a very positive effect on the treatment.

Sluggish, or low-progressing, schizophrenia is a chronic endogenous progressive disease, in which there are no productive symptoms characteristic of schizophrenia and profound personal changes. The progression of the disease is less pronounced than in schizophrenia, the emotional-volitional defect develops at later stages. The debut of a sluggish form of pathology falls on adolescence, but as a result of mild symptoms, it is not possible to immediately recognize the disease.

Show all

General information

It has been proven that among the forms of schizophrenia, which are most common in the practice of internal diseases, sluggish and latent prevail, which account for 82% versus 18% of cases in hospitals and clinics and about 70% versus 30% in offices of neuroses. The disease is common among women and men with the same frequency.

In the International Classification of Diseases (ICD-10), the diagnosis of "neurosis-like schizophrenia" is coded under the heading "schizotypal disorder" under the code F21. 3.

For the first time the term "latent schizophrenia" was used in 1911 by E. Bleuler.

According to Bleuler, the diagnosis of low-progressing schizophrenia can be made only after a retrospective study of the condition of patients: when studying the past of patients, in whom, after some time, manifested typical schizophrenia, prodromal signs of a sluggish process were often found. As such signs E. Bleuler identified a number of varieties of depression, hypochondria, hysteria, phobias, psychasthenia, neurasthenia.

The reasons for the development of sluggish schizophrenia are poorly understood, but, undoubtedly, the main role in the onset of the disease is played by disorders in the ratio of the central mediators of the nervous system (glutamate-dopamine-serotonin-norepinephrine, ergic and other systems). The fact that the presence of such a diagnosis in relatives increases the likelihood of developing low-grade schizophrenia speaks in favor of a genetic theory of mental disorder.

Clinical manifestations

The criteria for the clinical picture of sluggish schizophrenia, as in the "typical" variant of the disease, are characterized by the manifestation of two main symptom complexes:

1.pathological negative syndrome (psychopathological defect in the form of a decrease in previous interest, drives, desires);
2. psychopathological productive symptoms.

There are three successive stages in the course of low-grade schizophrenia (according to A.B.Smulevich):

1. Latent, in which there are no specific signs of manifestation, the phenomenon of progression against the background of the emergence of insignificant latent symptoms in the behavior of patients (observed by the so-called symptom "fershroben").
2. The active phase, or the period of the full height of the disease, which is characterized by the manifestation of the disease with the appearance of positive or negative signs in the form of one or a series of seizures with a tendency towards continuity to progression.
3. The stage of stabilization with personality changes that come to the fore, reduction of productive symptoms and the formation of further signs of compensation.

The following forms of the course of neurosis-like schizophrenia are shared:

obsessive-phobic (with various fears, manifestations of obsession with thoughts and actions);
depersonalization or derealization;
hypochondriacal;
hysterical (with hysterical manifestations);
simple form (poor) - with a predominance of negative symptoms.

Sluggish neurosis-like schizophrenia is mainly manifested by obsessions and phobias. Of the most common, they note the fear of being in open, crowded rooms (agoraphobia), contracting an infection, contracting an incurable disease (heart attack, cancer, syphilis, AIDS). Unlike neuroses (especially in obsessive-compulsive disorder), all these phobias in neurosis-like schizophrenia are distinguished by pretentiousness, delusional interpretation, and can change significantly in the course of a short time. For example, with the initial fear of traveling only on trains, over time, there is a fear of movement in any type of transport. To overcome their obsessive phobias, patients with neurosis-like schizophrenia come up with strange distracting operations, actions that eventually acquire the character of absurdity and pretentiousness.

The fear of “contaminating your hands and body” can develop into the fear of “contracting any infection from microbes” with the development of an obsessive struggle with dirt, the habit of daily washing your clothes separately from others, and wiping your clothes with wet wipes from imaginary dirt every minute. After some time, the patient may leave work, school, stop communicating with relatives and friends, and stop going outside just to avoid contact with any infection.

The disease occurs so imperceptibly and develops rapidly that it is not possible to establish the time of its appearance. Emotional monotony gradually increases, the patient's activity decreases, the circle of previous interests narrows, some eccentricities arise in behavior, speech and thinking become pretentious, with elements of resonance. Along with emotional impoverishment, various obsessions, fears, mild depression, hysterical symptoms gradually join. All these changes develop over many years with the progression of the disease and the growth of negative symptoms.

An important symptom that characterizes the onset of the manifestation of sluggish schizophrenia - "fershroben" - is eccentricity, pronounced foolishness, strangeness in behavior, which is characterized by absurdity in appearance, slovenliness. Patients have angular, unsteady movements like small children. Changes are also observed in the conversation - their speech is accelerated in pace, overflowing with all sorts of pretentious turns, interrupted thoughts can be observed. Mental and physical activity is always preserved.

In neurosis-like schizophrenia, episodic quasi-psychotic symptoms (illusions, hallucinations, delusions of persecution) can rarely occur, but in most cases these manifestations will be the prodrome of clinically delineated schizophrenia.

Schizophrenia in Men - Symptoms, Behavior and Treatment

Flow stages

Latent period. Clinical manifestations of the latency period are most often limited to a small range of affective and psychopathic disorders, phenomena of reactive lability, obsessions. Among psychopathological disorders, schizoid traits stand out, often combined with signs of hysterical, paranoid, or psychosthenic personality disorder. In the affective sphere, disorders in most cases are manifested by erased somatized or neurotic depressions, a prolonged hypomanic symptom with a monotonous and persistent affect. The clinical picture of the initial (latent) stage of sluggish schizophrenia in some cases can be limited only by specific options for responding to external influences, often repeated in the form of a series of attacks of 3 or more somatogenic or psychogenic disorders (depressive, depressive-hypochondriac, hysterical-depressive, in rare cases - litigious or delusional).

A. B. Smulevich proved that in the latent period mental disorders are not very specific and often manifest themselves only at the behavioral level; in children and adolescents, there are reactions of avoidance (especially with the phenomena of social phobia), refusal (from food, passing exams, leaving the house), states of insolvency (well-known periods of adolescence).

Active period and stabilization . The clinical picture of the most common variant of latent schizophrenia occurs with disorders of the obsessive-phobic spectrum and manifests itself in a wide range of obsessions, anxious and phobic symptom complexes:

constant obsessive doubts about the completeness, completeness of their actions, accompanied by rituals and rechecking (doubts about the purity of the surrounding objects, clothes, and their bodies);
actions that acquire the character of complex habits (rituals), pretentious actions, obsessive mental operations (repetition of sounds, certain words, obsessive counting, etc.);
panic attacks that are atypical;
phobias of contrasting content, fear of losing control over oneself, insanity, fear of possible harm to oneself or others;
fears of darkness, heights, being alone, fires, thunderstorms, fear of blushing in public;
fear of an external threat, accompanied by protective rituals (fear of pathogenic bacteria, poisonous substances, sharp objects, etc.) entering the body.

Types of flow

The erased variants of schizophrenia proceed with the phenomena of derealization and depersonalization and are characterized by feelings of alienation in the autopsychic sphere (mental impoverishment, awareness of a changed inner world), a decrease in initiative, activity and vitality of manifestations. A detached understanding of the reality of objects and phenomena, a lack of a sense of appropriation and ownership, a feeling of loss of sharpness and flexibility of the intellect prevail. In cases of chronic depression in the clinic, manifestations of "painful anesthesia" prevail: the loss of the ability to feel subtle shades of feelings, to receive displeasure and pleasure, and the lack of emotional resonance.

With the hypochondriacal variant of schizophrenia, the clinical picture consists of anxiety-phobic manifestations of a hypochondriacal nature and senestopathies. Allocate:

senestopathic hypochondria, which is characterized by a variety of artsy, changeable, diffuse senestopathic sensations;
a non-delusional form of hypochondria, which is characterized by a sharp appearance of fears and phobias of a hypochondriacal nature (fear of contracting any unrecognized or rare infection, carcinophobia, cardiophobia) with episodes of anxiety-vegetative manifestations, fixation and obsessive observations of the slightest somatic manifestations to overcome overvalued and subsequent endless visits to different doctors, conversion (hysterical) symptoms.

With the predominance of the hysterical component, the main symptomatology will be characterized by demonstrative, exaggerated forms: stereotyped, rude hysterical reactions, flirtatiousness and mannerism with traits of immorality, hypertrophied theatricality, etc., while conversion disorders enter into complex combined connections with obsessive drives, fears, vivid mastering ideas and senesto-hypochondriacal symptom complexes. With the progression of the disease (stabilization period), gross psychopathological disorders (vagrancy, adventurism, deceit) and negative manifestations come to the fore in the clinical picture, as a result of which the patients are depressed, lonely eccentrics, fenced off from society, but pretentiously dressed, attracting to themselves attention to the abuse of cosmetics, odd hairstyles.

Simple low-grade schizophrenia is characterized by signs of apathy, asthenia with impaired activity of self-awareness: disorders of the anergic component with monotony, extreme poverty and fragmented manifestations predominate; depressive disorders with an affective negative coloration (asthenic, apathetic depression with a deficit of symptoms and a paucity of clinical picture); with bipolar disorders - an increase in physical and mental asthenia, the phenomena of anhedonia, a gloomy and depressed mood, a sense of alienation, senesthesia and local senestopathies. Over time, there is a gradual increase in mental fatigue, passivity, sluggishness, rigidity, complaints of memory and difficulty concentrating.

Forms of sluggish schizophrenia

Sluggish schizophrenia is divided into negative, positive and residual. With a negative course, we are talking about senesthetic schizophrenia; with a variant with a predominance of positive manifestations - about organoneurotic; with residual - about the residual symptoms of pathology with the phenomena of bodily phenomena.

Negative (senesthetic schizophrenia) - dominance in the clinical picture of pathological somatic sensations (vague, indefinite, changeable, diffuse, sensations difficult for subjective expression). They can be characterized by pseudo-vestibular (impaired coordination of movements, balance, feeling of "cotton feet", unsteadiness of gait), sensory (changes in the quality and intensity of olfactory and auditory sensations, a feeling of fuzziness, uncertainty in assessing distance, blurry, distorted vision) and kinesthetic (tension or muscle spasm, feeling of "muscular emptiness", stiffness in the limbs, imaginary movement) sensations. In the process of dynamic observation, the manifestations of asthenic syndrome with a clinic of pronounced weakness, passivity, lethargy, lack of initiative become more and more distinct.

Positive (organoneurotic schizophrenia) - the debut of an endogenous process in the form of an organ neurosis (false neurosis), but unlike the true one, it is characterized by manifestations of overvalued or neurotic hypochondria with delusional symptoms. With neurotic hypochondria, the clinic is dominated by functional disorders of the respiratory (hyperventilation syndrome) and cardiovascular (vegetative-vascular dystonia, Da Costa syndrome, cardioneurosis) systems. Against the background of the progression of organoneurotic disorders, nosophobia is often formed in the form of fears for one's health with the addition of senestopathies, senestalgia, anxiety and phobic symptom complexes, up to the development of generalized anxiety and panic paroxysms. Panic attacks in these cases are characterized by severity, atypicality (attacks can last up to several days).

If hypochondriac schizophrenia is associated with disorders of the gastrointestinal tract (biliary dyskinesia, irritable stomach and intestinal syndrome), a picture of rigid (overvalued) hypochondria begins to form. Against this background, all thoughts and behavior of the patient are determined by the desire to overcome the disease by all means and at any cost through a complex of eccentric, unconventional, sometimes life-threatening measures aimed at improving health. Patients continue to search for wellness treatments, while functional disorders of the digestive system are gradually reduced. This progression of organoneurotic schizophrenia is characterized by auto-aggressive behavior (traumatic and strange ways of "healing") and ends with the formation of signs of a psychopathic defect with the traits of "Fershroben".

Residual schizophrenia is characterized by residual symptoms with symptoms of somatic sensations. Somatic fantasies (fantastic senestopathies) - pretentious, unusual sensations, often formed as a result of a true somatic illness, come to the fore as the main manifestations. These somatic manifestations are mainly represented by a symptom complex of disorders of the autonomic nervous system (unpleasant, painful, sometimes absurd sensations of movement, compression, decrease, increase, pressure from the internal organs - the stomach "touches" other organs when digesting food, the heart "rubs" during deep breathing about the pleura, etc.).

Diagnostics

Most people with sluggish schizophrenia have no criticism of their condition, therefore, such patients rarely go to the doctor on their own, which is fraught with great difficulties and aggravates the course of the disease. In such cases, relatives play a huge role, who are the first to notice changes in the behavior of patients.

If you find symptoms that resemble neurosis-like schizophrenia, you should consult a psychiatrist or psychotherapist. It is these specialists who will help a person cope with the problem that has arisen.

Treatment

In psychotherapy of sluggish schizophrenia, the individualization of psychotherapeutic treatment is important. It is important to choose the most effective option for psychotherapeutic assistance for each patient, regardless of whether it is individual or group psychotherapy. Based on practice, the most effective method of psychotherapy is an integrative approach. Elements of family psychotherapy are also used, which help to normalize relationships with relatives. The main objectives of therapy for neurosis-like schizophrenia:

1. Social activation of patients and normalization of responses in response to situations associated with disease and treatment.
2. Prevention of isolation of patients in society and autism.
3. Potentiation of the antipsychotic action of pharmacological treatments.
4. Deactualization of mental experiences and the formation of a critical perception of the disease.
5. Preparation of patients for discharge and prevention of nosocomial hospitalism.

With a general consideration of the significant factors for the favorable social and labor adaptation of patients with sluggish schizophrenia for all variants of its course, the important role of family psychotherapy, supporting treatment with psychotropic drugs (neuroleptics and tranquilizers), measures for social and labor rehabilitation and the elimination of exogenous hazards should be noted.

Drug treatment should pursue 2 objectives:

1. relief of positive symptoms;
2. reduction of negative manifestations.

The recognized class among all groups of psychotropic drugs in the complex pharmacotherapy of neurosis-like schizophrenia are antipsychotics. Recently, it has been proven that the use of traditional strong medicines of this class leads to a number of side effects, therefore, new generation antipsychotics (atypical antipsychotics) have advantages. The introduction of "small" neuroleptics into clinical psychopharmacology improves the prognosis for the life of patients with sluggish neurosis-like schizophrenia.

Drugs from the group of atypical antipsychotics stop not only positive symptoms, but also negative manifestations, normalize cognitive functions and have a smaller spectrum of side effects, increasing adherence to therapy.

With overvalued ideohypochondria, Zyprexa (olanzapine), Abilify (aripiprazole), Fluanksol (flupentixol), Rispolept (risperidone) and Azaleptin (clozapine) are prescribed. If we are talking about neurotic senesto hypochondria, which proceeds mainly with manifestations of pathological bodily sensations, the appointment of quetiapine (quetiapine), Eglonil (sulpiride), Solian (amisulpride) and Azaleptin is recommended.

The therapy of the organoneurotic variant is carried out in several stages, and at the initial stages of the course of the disease, treatment is carried out in institutions of the general medical network with the consultative participation of a psychotherapist and a psychiatrist. At the first stage of complex psychopharmacotherapy, agents from the group of antidepressants of the latest generations are used - serotonergic drugs, including Prozac (fluoxetine), Tsipramil (citalopram), Coaxil (tianeptine) and complex antidepressants: Remeron (mirtazapine), Ixel (milnacipran) in combination with taking antipsychotics and tranquilizers. With the development of resistance, they switch to the second stage of therapy, characterized by the appointment of traditional antipsychotics (Chlorprothixene, Haloperidol) in combination with tricyclic antidepressants (Amitriptyline, Anafranil).

An integrated approach to the treatment of hypochondriacal forms of schizophrenia, along with psychopharmacotherapy, includes psychotherapy, which is carried out differentially depending on the variant of the disease: negative - positive - residual. In the first case, a course therapy with tranquilizers and atypical antipsychotics is used. In the second option, intensive psychopharmacotherapeutic methods are prescribed (combination therapy with modern antidepressants and atypical antipsychotics with the addition, if necessary, of tranquilizers with parenteral administration of drugs in medium or high dosages). In the third, supportive, corrective therapy with low doses of antipsychotics (atypical and traditional, depending on resistance) in enteral form.

Treatment of hypochondriacal forms of sluggish schizophrenia with manifestations of pronounced resistance to therapy, requiring the appointment of intensive techniques (third stage), is carried out in specialized institutions and prefers parenteral administration of tricyclic antidepressants in combination with neuroleptics (Haloperidol, Sulpirid) and tranquilizers (Elsepam).

Sluggish schizophrenia is one of the few types of mental illness that is usually not accompanied by the appearance of pronounced productive symptoms, that is, delusions and hallucinations. This type of schizophrenia is the most favorable, since with proper treatment, complete remission can be achieved. The thing is that a sluggish type of schizophrenia is characterized by an extremely slow development of this mental illness, which leads to minimal mental disorders, the ability to think processes and an adequate perception of the world around us.

Some researchers believe that it is wrong to call schizophrenia sluggish in a certain sense, and it would be more correct to consider such manifestations in a person as schizotypal disorder or low-grade schizophrenia. Such a schizotypal disorder can be easily stopped with medication, and if patients follow preventive measures, unpleasant symptoms will manifest themselves extremely weakly or not at all.

Symptoms

According to statistics, low-grade schizophrenia in women is much more common than in men. For a long time, the symptoms caused by such a schizotypal personality disorder can be so subtle and mild that most people around them perceive the existing manifestations as minor personality traits. At the same time, it should be borne in mind that sluggish schizophrenia, like any other type of this mental illness, has several stages of development, including:

latent;
active;
stabilization.

During the latency period, a person with sluggish schizophrenia may experience only minor manifestations, including refusal to communicate with other people, prolonged depression, somatic reactions, social phobia, etc. If the treatment of sluggish schizophrenia in women has not been carried out, bouts of exacerbation of the course may be observed, accompanied by severe tantrums, progressive hypochondria, in which a person begins to experience an irrational fear that he has some kind of terrible disease.

Such neurosis-like schizophrenia during an exacerbation makes a person simply unbearable and touchy, which often becomes the reason that many relatives and friends refuse him. Often, against the background of the progression of sluggish schizophrenia, patients may experience such a pathological condition as depersonalization. This state is characterized by the feeling that all the actions that the patient performs are perceived by him as a detached one, as if he is an outside observer of all the events in which he was directly involved.

People suffering from sluggish schizophrenia, as a rule, maintain a sobriety of thought, can perfectly add logical chains without obvious errors, but at the same time they have a number of irrational fears and phobias that determine their damage. Signs of sluggish schizophrenia in women may increase significantly during pregnancy and childbirth. In women suffering from such a schizotypal disorder, exhaustion and labor are much more likely to provoke the development of postpartum depression. The reasons for the exacerbation of sluggish schizophrenia after childbirth can be rooted in the changes in the hormonal background during this period.

Treatment methods

Given that sluggish schizophrenia has very minor symptoms, many people suffering from this mental illness do not receive adequate medical care due to the lack of timely diagnosis.

Treatment at an early stage of development of sluggish schizophrenia guarantees a quick and very high-quality effect.

It is important to note that people suffering from such a schizotypal disorder do not need urgent hospitalization, routine hospital examinations and home treatment. If you have any concerns about the presence of sluggish schizophrenia, you should not think that the treatment will take place within the walls of a psychiatric hospital and under the close supervision of doctors. Treatment for people with a disorder such as low-grade schizophrenia includes:

drug support;
psychocorrection;
socialization;
encouragement to work or creative activity.

Usually, in order to eliminate the existing symptoms, drugs belonging to the group of antipsychotics are selected, and in maintenance dosages. A person suffering from sluggish schizophrenia should definitely undergo treatment with a psychotherapist, as this will allow him to quickly get rid of existing phobias and strange behavior, and then acquire the skills of interacting with other members of society. In addition, you need to pay special attention to the fact that some people suffering from sluggish schizophrenia feel a surge of creative energy. It is very important to maintain such aspirations, since creativity allows the release of those emotions that a person is trying to suppress. Manifesting oneself in creativity allows a person suffering from sluggish schizophrenia to quickly regain confidence and learn to be part of a social society again.

- This is one of the varieties of schizophrenia, characterized by a slow progression of the disease, the absence of schizophrenic and obvious productive symptoms of the disease. Clinical manifestations are blurred enough, personality changes are superficial.

You can find the term low-grade schizophrenia or schizotypal disorder, which doctors also designate sluggish schizophrenia. In addition, the following definitions of this mental disorder are found: pre-phase, sanatorium, micro-procedural, occult, non-psychotic, pseudo-neurotic illness.

An important distinguishing feature of this type of schizophrenia is the lack of progression. This means that the patient does not degrade after some time, the symptoms of the disease will not intensify, and the personality does not transform. In addition, people with sluggish schizophrenia do not suffer from delusions and hallucinations, they are characterized by other neurotic disorders.

Symptoms of sluggish schizophrenia

It is rather difficult to determine the symptoms of this subtype of schizophrenia, due to the peculiarities of its course.

A sluggish disorder can proceed as follows:

With a predominance of symptoms of paranoia, with a predominance of disturbances in thinking and perception, with malfunctions of limb motility and facial expressions.

With signs of hysteria: with an obsessive desire to take leading positions in society, with a desire for admiration and surprise. This is expressed in a vulgar, noisy behavior, frequent mood changes, unsteadiness in gait, increased tremors of the limbs and head in moments of excitement. Sometimes such patients have hysterical seizures with sobbing, beating themselves, etc.

With signs of hypochondria, which is combined with increased anxiety, with a desire to analyze the natural processes taking place in the body. Often such patients have an obsession with their incurable disease, and they perceive the absence of any pathological symptoms as a signal of imminent death.

By the type of asthenia with a predominance of asthenic-depressive syndrome, with increased fatigue, with frequent mood swings. Such patients are withdrawn, hardly make contact, strive for solitude.

According to the type of obsessive-compulsive disorder, when patients suffer from various obsessions, thoughts, manias. Most often this manifests itself in various phobias, in unreasonable anxiety, in regularly repeated actions.

However, whatever the type of the disease, the person must always have one or more defect characteristic of sluggish schizophrenia.

They are characterized by the following symptoms:

Pseudo-psychopathization. It is expressed in the fact that a person simply abounds in various and extremely important, in his opinion, ideas. He is always in high spirits, emotionally charged. The patient takes an active interest in the people around him, tries to prove his point of view to them, so that they help him to put his ideas into practice. The disease in this case is manifested in the fact that all ideas seem valuable only to their bearer. In addition, the result of his activity does not lead to anything, it is zero.

Vershroiben. In this case, the patient is separated from reality, he forgets past life experience, shows pathological. This is expressed in strange behavior, in stupid actions. A person does not realize all the absurdity of his worldview, he is surprised if he finds out that he is considered wonderful. In the house of such a person there are many old things, unnecessary trash, his home is unkempt, and his appearance is untidy. Patients often completely ignore personal hygiene. Speech disorders are observed, which is expressed in a detailed description of absolutely unimportant details. The phrases are rather lengthy, they do not make sense. Often such patients adhere to a certain idea and give all their strength to realize it, for example, they recount the letters in great works. However, despite the strangeness in behavior, such people are capable of work and study.

Energy potential reduction defect. The circle of interests of such people is narrowed, contacts are limited. The patient tries to avoid any vigorous activity, refuses to work. He does not strive for knowledge, for creative development, often completely passive and indifferent to everything. At home he feels as comfortable as possible and does not want to leave it.

Stages of sluggish schizophrenia

The disease takes place in several stages:

Debut or latent stage, which can be unnoticed even by close people. Its symptomatology is dim, blurred. The patient has protracted hypomania, somatized depression, persistent affects. This stage occurs during puberty. Teenagers may refuse to take an exam, stop leaving the house, and avoid socializing with other people.

Manifested or active period when there is an increase in the clinical symptoms of the disease. It was at this time that certain oddities begin to notice a person, however, relatives may not seek help. Relatives do not perceive the eccentric behavior and statements of a schizophrenic as signs of illness, since there are no hallucinations and delusions. At this time, the patient himself suffers from panic attacks, experiences fears. In order to overcome them, such people often resort to rituals and rechecking (cleanliness of clothes, their own body, etc.).

Stabilization. The patient behaves absolutely normally, the entire clinic, which manifested itself at the stage of manifestation, calms down. Stabilization can continue for a long time.

Treatment of indolent schizophrenia

When a patient is diagnosed with schizophrenia, he needs psychiatric treatment. First of all, it consists in taking medications. It is worth remembering, whatever remedy the doctor prescribes, it must be taken without omissions. Only strict adherence to the treatment regimen can give a positive effect.

Therapy with traditional antipsychotics. These drugs are aimed at blocking dopamine receptors. Highly potent traditional antipsychotics are characterized by stronger bonds with dopamine receptors and weaker ones with muscarinic and adrenergic receptors. Low-potency antipsychotics are used less often, since they have a weak affinity for dopamine receptors and somewhat greater affinity for histamine, adrenergic, and muscarinic receptors. The choice of this or that remedy depends on what route of administration is required, the patient's condition and the severity of possible side effects are also assessed. It is worth noting that they can be quite serious, such as: muscle rigidity and dystonia, dullness of consciousness, etc. These drugs include: Chlorpromazine, Thioridazine, Molindone, Thiothixene, Haloperidol, Fluphenazinedecanoate, Haloperidol Decanoate and others.

Second generation antipsychotics. These drugs are capable of influencing the work of not only dopamine, but also serotonin receptors. Their advantage over the first generation means is less pronounced side effects. The issue of greater effectiveness in relation to the symptomatology of the disease remains controversial. These drugs include: Risperidone, Clozapine, Olanzapine, Quetiapine, Aripiprazole, Ziprasidone. While taking these medicines, it is necessary to carefully monitor the patient's body weight, as well as monitor for possible signs of developing type 2.

In addition to receiving drug therapy, patients are in no less need of social support. Trainings in psychosocial skills, programs aimed at professional rehabilitation of patients must be used. This allows people with sluggish schizophrenia to continue working, take care of themselves on their own, and feel comfortable in society.

In no case should close people close their eyes to violations in the behavior of a loved one. Only a comprehensive approach to treatment, together with a psychotherapist, a psychologist, and social workers, will allow the patient to live a full life.

During the manifest period, the patient may need to be hospitalized. You should not give it up if the doctor insists on it. However, it is also impossible to artificially prolong the patient's stay in the hospital. Staying too long in the hospital can aggravate the severity of symptoms. People living in a family avoid exacerbations longer.

It is important to involve patients in creativity. For this, there are special art therapies that are popular among practicing psychologists. People with sluggish schizophrenia are shown visiting cultural places accompanied by a healthy person; you should not hide him from society or be ashamed of somewhat unusual behavior. All doctors are unanimous in the opinion that if a patient shows a craving for creativity, he should be supported in this, not to hinder self-realization.

Prediction and prevention of attacks of sluggish schizophrenia

The disease has a favorable prognosis. With an integrated approach to treatment, seizures will be observed extremely rarely. Such patients will remain active members of society and will be able to fully fulfill their work duties.

To reduce the risk of recurrence of the disease, you must adhere to the treatment regimen prescribed by the doctor. Often, it is the self-withdrawal of drugs that leads to an increase in the frequency of seizures. In addition, it is important to avoid conflicts in the family, to strive to protect the sick person from possible ones as much as possible.

Education: In 2005 he completed an internship at the IM Sechenov First Moscow State Medical University and received a diploma in neurology. In 2009 completed postgraduate studies in the specialty "Nervous Diseases".