Schizophrenia paranoid episodic type. Continuous flow type. Stages of development of schizophrenia

Schizophrenia- A fairly common mental illness. It is manifested by disturbances in thinking, perception, emotional-volitional disorders and inappropriate behavior. The term “schizophrenia” was proposed by the Swiss psychopathologist E. Bleuler. Literally it means “splitting of the mind” (from the ancient Greek words “σχίζω” - split and “φρήν” - soul, reason, mind).
Despite high level development modern medicine, establish the exact cause of the occurrence of this disease still hasn't succeeded. Psychiatrists are more inclined to the genetic theory of the occurrence of schizophrenia. It says: if there is a person with schizophrenia in the family, then his blood relatives have a high risk of developing this pathology. However, the mode of inheritance and molecular genetic basis of the disease are unknown. An important role in the development of schizophrenia is played by personality traits, low social status (poverty, poor living conditions, dysfunctional family, etc.), various diseases(drug addiction, alcoholism, chronic somatic pathologies, traumatic brain injuries, protracted psychotraumatic situations, etc.) Sometimes the onset of schizophrenia is preceded by stressful influences, but in most patients schizophrenia occurs “spontaneously”.
TO typical forms of schizophrenia include paranoid, hebephrenic, catatonic and simple forms.

  • Paranoid form (F20.0) Most often in their practice, psychiatrists encounter the paranoid form of schizophrenia. In addition to the main signs of schizophrenia (impaired thinking, autism, decreased emotions and their inadequacy), the clinical picture of this form is dominated by delirium. It typically manifests as delusions of persecution without hallucinations, delusions of grandeur, or delusions of influence. Signs of mental automatism may occur when patients believe that someone from the outside is influencing their own thoughts and actions.
  • Hebephrenic form (F20.1) The most malignant form of schizophrenia is hebephrenic. This form is characterized by manifestations of childishness and silly, absurd excitement. Patients grimace, can laugh for no reason, and then suddenly become indignant, show aggression and destroy everything in their path. Their speech is inconsistent, full of repetitions and words they have invented, and very often accompanied by cynical abuse. The disease usually begins in adolescence(12-15 years) and progresses rapidly.
  • Catatonic form (F20.2) The clinical picture of the catatonic form of schizophrenia is dominated by disorders motor function. Patients remain in unnatural and often uncomfortable positions for long periods of time without feeling tired. They refuse to follow instructions and do not answer questions, although they understand the words and commands of the interlocutor. Immobility in some cases (catalepsy, a symptom of a “mental (air) cushion”) is replaced by attacks of catatonic excitement and impetuous actions. In addition, patients can copy facial expressions, movements and statements of their interlocutor.
  • Simple form (F20.6) The simple form of schizophrenia is characterized by an increase in exclusively negative symptoms, in particular, apathetic-abulic syndrome. It is manifested by emotional poverty, indifference to the world around us, indifference to oneself, lack of initiative, inactivity and rapidly increasing isolation from the people around us. At first, a person refuses to study or work, breaks off relationships with relatives and friends, and wanders. Then, gradually, he loses his accumulated knowledge and develops “schizophrenic dementia.”
Atypical forms of the disease - In the clinic of atypical forms of schizophrenia, non-standard, not entirely characteristic signs predominate. TO atypical forms include schizoaffective psychosis, schizotypal disorder (neurosis-like and variant), febrile schizophrenia and some other forms of schizophrenia.
  • Schizoaffective psychosis- This special condition, which is characterized by the paroxysmal occurrence of schizophrenic (delusional, hallucinatory) and affective symptoms(manic, depressive and mixed). These symptoms develop during the same attack. At the same time, the clinical picture of the attack does not meet either the criteria for manic-depressive psychosis or the criteria for schizophrenia.
  • Neurosis-like variant Schizotypal disorder is manifested by asthenic, hysterical symptoms or obsessive phenomena that resemble the clinic of corresponding neuroses. However, neurosis is a psychogenic reaction to a traumatic situation. Schizotypal disorder is a disease that occurs spontaneously and does not correspond to existing frustrating experiences. In other words, it is not a response to stressful situation and is characterized by absurdity, deliberateness, and also isolation from reality.
  • In extremely rare cases, acute psychotic states with signs of severe toxicosis occur, called febrile schizophrenia. Patients have heat, the symptoms of somatic disorders are increasing (subcutaneous and intraorgan hemorrhages, dehydration, tachycardia, etc.) The clinic of mental disorders is characterized by confusion, the appearance of delirium of fantastic content and catatonic syndrome. Patients are confused, rush around in bed, make meaningless movements, cannot say who they are and where they are. Febrile schizophrenia should be distinguished from neuroleptic malignant syndrome. This is a fairly rare life-threatening disorder associated with the use of psychotropic drugs, most often antipsychotics. Neuroleptic malignant syndrome is usually manifested by muscle rigidity, increased body temperature, autonomic changes and various mental disorders.
TO rare forms of delusional psychoses include chronic delusional disorders(paranoia, late paraphrenia, etc.), acute transient psychoses.
Highlight three types of schizophrenia : continuous, periodic (recurrent) and paroxysmal-progressive (coat-like).
  • Continuous schizophrenia. This type of schizophrenia is characterized by steadily progressive dynamics. Depending on the degree of its progression, a malignant, moderately progressive and sluggish course is distinguished. With a continuous course, there are periods of exacerbation of schizophrenia symptoms and their weakening. However, full-fledged high-quality remissions are not observed. The clinical and social prognosis for the majority of such patients is unfavorable. The vast majority of patients undergo hospital treatment or are in psychoneurological boarding schools. All of them sooner or later receive the first group of disability. In some patients, many years after the onset of the disease, the clinical manifestations and thanks to this they are kept at home, remaining unable to work.
  • Periodic (recurrent) schizophrenia. With this type of schizophrenia, attacks of productive mental disorders occur periodically and are not accompanied by profound personality changes. Their number varies. Some people have one attack in their entire life, others have several, and others have more than ten. Attacks of schizophrenia can last from several days to several months. They are of the same type ( similar friend to each other) or heterogeneous (dissimilar to each other). The medical and social prognosis for periodic schizophrenia is usually quite favorable. This is explained by the insignificant severity of negative personal changes or their absence due to persistent intermission or practical recovery. The prognosis worsens with the severity, lengthening and frequency of attacks of recurrent schizophrenia.
  • Paroxysmal-progressive schizophrenia. The most common paroxysmal-progressive course of schizophrenia occurs. This variant of the course is characterized by the presence of episodic attacks of schizophrenia with incomplete, low-quality remissions. Each attack leads to a personality defect, as well as increased delusions and hallucinations. The degree of progression of fur coat-like schizophrenia and the depth of the mental defect may vary. Clinical and social prognosis of this type The course of schizophrenia is determined by the rate of increase in personality changes, as well as the duration, frequency and severity of attacks. Fur-like schizophrenia with a rapidly developing mental defect has an unfavorable prognosis. A relatively favorable prognosis for sluggish fur-like schizophrenia. It is characterized by the rare occurrence of attacks that are non-psychotic in nature. The remaining cases are at intermediate levels between the indicated extreme options.

Nursing process in psychiatry: schizophrenia

Behavior is an integral part of treatment medical personnel. In the hands of the sister is the life of a patient who at any moment can harm himself or others.

  • Medical staff within the walls of a psychiatric clinic have to deal with people with completely different thinking and complex mental disorders. Workers must familiarize themselves with the patient’s data in detail - know the patient’s last name, first name, patronymic and the number of the room in which he is located. Treatment should be correct, affectionate and individual to each individual patient. The nurse is obliged to remember by heart what prescriptions the attending physician made for this or that patient and strictly follow them.
  • Many people mistakenly believe that mentally ill people do not notice a polite attitude. On the contrary, they have a very delicate sensitivity and will not miss the slightest change in intonation and highly value good nature. But at the same time, it is worth remembering that a “golden mean” is necessary; the staff should not be too rude, nor too soft, ingratiating. It is strictly forbidden to single out among patients those who would like to be given preference more often in help, care, and then immediately neglect others.
  • It is important to maintain a normal environment within the clinic; everyone should know their responsibilities. Loud talking, shouting, and knocking are not allowed, since the main condition in psychiatric clinics for the peace of mind of patients is peace and quiet.
  • Female staff should not wear shiny items: jewelry, earrings, beads, rings, as patients can tear them off. This is especially true in departments where patients with serious forms of the disease are treated.
  • If there is a sudden change in the patient’s condition or changes in his speech, the nurse must immediately notify the attending or duty doctor about this.
  • You cannot have conversations with colleagues in the presence of patients, especially discussing the condition of other patients. It is unacceptable to laugh or treat wards with even the slightest degree of irony or jokes.
  • In most psychiatric clinics, at the moment acute phase illness, visiting is prohibited. Therefore, relatives pass notes and letters to their loved ones, which should be read before handing them over. If they contain information that could aggravate the patient’s condition, transmission is prohibited, and a conversation with relatives will be required. When transferring things or products, you must carefully inspect each package: there should be no sharp, cutting, piercing objects, matches, alcohol, pens, or medications.
  • In charge nurse includes supervision of orderlies. She must clearly set tasks to complete and monitor their implementation. Constant supervision in such establishments - important condition. Thus, patients will not be able to injure themselves or their companions, commit suicide, escape, etc. Patients in psychiatric clinics should not be left alone for a minute and should not be out of sight of the staff. If the patient is covered with a blanket, you need to go up and uncover his face.
  • Temperature taking and medication administration must also be strictly supervised. For suicide purposes, the patient may injure himself with a thermometer or swallow a thermometer. Do not turn away or leave the room until the patient drinks them in front of the nurse.

Attempts have been made to bring such a disease as schizophrenia to a general classification various doctors V different time. The pathology was first extensively described in 1911 by Eugen Bleuler. He described the forms and types of schizophrenia, which are still used to classify the disease today.

Types of schizophrenia

There are two main types of disease, according to clinical manifestations:

  • paroxysmal-progressive;
  • continuously progressive.

Paroxysmal-progressive type

Coat-like or paroxysmal-progressive schizophrenia is intermediate view flow between recurrent and continuously flowing form. main feature pathologies in sharp, spasmodic clinical manifestations. They arise suddenly and can last indefinitely, depending on the severity of the attack.

This form of schizophrenia begins to develop in early age. As a rule, these are children of preschool age; during this period the first symptoms begin to appear. They manifest themselves in the form of isolation and distance from society; the child prefers to spend time alone. I'm having problems visiting kindergarten, and then schools.

Regarding the course of fur coat-like schizophrenia, two periods are distinguished in it: phase and fur coat. The period of the phase is characterized by an increase in negative symptoms, while at the initial stage, the emerging signs do not greatly disturb the patient and those around him. But over time, the phase moves into another period - fur coats. It is characterized by an increase productive symptoms such as hallucinations, delusions and manifestations of catatonia. Patients are often in a state of agitation and may behave bizarrely.

The phase and fur coat alternate, the time of each period is individual. In some cases, one condition can last for several years without being replaced by another. In the second option, the phase change in the fur coat occurs throughout the year, and sometimes several times. The longer the disorder exists, the shorter the intervals between changes from one condition to another become. At the same time, positive symptoms become less vivid, and negative signs increasingly absorb the human psyche. Sometimes productive signs can develop into chronic form and not stop even during the phase.

The goal of treatment is to reduce the rate of development of negative symptoms and prevent the onset of another mental episode (fur coat). For treatment, as a rule, a combination of several antipsychotic drugs is used, if necessary, antidepressants, as well as psychotherapy.

Continuously progressive type

This type of disease may develop in at different ages, the two most susceptible age periods- teenage and after 23 years. More often, men suffer from the continuous course of the pathology, while women are more susceptible to the paroxysmal type. Regarding the clinical picture, it partly depends on the form of schizophrenia. Distinctive feature of a continuously progressive type in that the disease, having reached its maximum severity, remains at this level, even if it does not weaken much. Remissions are rare and only with adequate and continuous treatment. If therapy is discontinued, the situation will certainly worsen. Spontaneous remissions, as in the paroxysmal type, are not observed.

The disorder usually develops gradually, starting with personality changes and associated negative symptoms. Volitional and emotional impoverishment is observed, patients become indifferent to everything that happens around them. A little later, increased excitability and even aggression towards others may occur. Afterwards positive signs appear, they are expressed in hallucinations and delusions, during this period the disease reaches its peak. Without treatment, the pathology results in an irreversible schizophrenic defect. The most unfavorable course is observed with the early onset of the disease, in adolescence. During this period, malignant paranoid or simple form of continuous schizophrenia most often develops.

Recurrent type

According to descriptions of this type, it affects predominantly middle-aged women (20-40 years old). The pathology is characterized by the occurrence of vivid and severe mental episodes, after which a long-term remission occurs. Obligate symptoms progress slowly, and personality changes begin to be observed only after a series of mental episodes. When remission occurs after the first or second episode, the patient seems absolutely healthy, no noticeable changes are observed. Psychoses can have three development options:

  • Oneiric catatonia, this condition manifests itself either in a stupor. The patient may long time to be in an uncomfortable and unnatural position, this state is often accompanied by mutism, that is, complete silence. In this case, not only the body takes an uncomfortable position, but also the facial expressions are absent, it becomes like a mask. Catatonia can also manifest itself as a state of excitement, stereotypical actions and impulsive aggression appear. The patient can break and destroy everything in his path;
  • A depressive-paranoid state manifests itself in depression with fears and anxiety. Delusions of staging and condemnation, as well as verbal illusions, arise. During remission, ability to work remains, although slightly reduced. Remission is accompanied by a feeling of anxiety with a somewhat pessimistic background;
  • bipolar schizophrenia in this case, the course of the disease is characterized by sudden changes in mood and emotional background. Frequent cases of suicide occur precisely with this form of development of a mental episode. Often there is an alternation between manic and depressive state. In this condition, the patient experiences speech disturbances, abruptness and incompleteness of thought, absent-mindedness and poor sleep.

An important role in the depth of recovery and aggravation of the situation in the course of schizophrenia depends on prescribed therapy. Both drug treatment and psychotherapy with patients and their relatives are important. For each individual case, a different set of drugs is prescribed, depending on which clinical manifestations dominate. Antipsychotic drugs are always the basis of treatment, and depending on the symptoms they are supplemented with antidepressants, nootropic drugs, vitamins, psychotropic substances, etc.

is a mental disorder that is characterized by a significant deformation of thinking and perception. Clear consciousness and intellectual abilities are usually preserved, although some cognitive defects may develop over time. The most important psychopathological features include vocalization of thoughts, delusions, and auditory hallucinations. Some patients comment or discuss themselves in the third person.

The following forms of schizophrenia are distinguished:

  • permanent;
  • episodic with increasing or persistent defect;
  • paroxysmal with complete or incomplete remission.

The diagnosis of schizophrenia is not made in the presence of extensive, manic manifestations, in the absence of evidence that schizophrenic symptoms preceded the affective disorder. Diagnosis of schizophrenia cannot be objective in the presence of an identified brain disease, during intoxication or drug withdrawal syndrome. If such disorders develop during epilepsy or other brain diseases, according to ICD-10 they are classified as F06.2, with participation in the development of psychoactive substances - F10-F19.

Continuous flow

The continuous type of schizophrenia accounts for about 50% of all cases of the disease. Productive symptoms are present all the time. In this context, negative disorders constantly intensify, spontaneous remission does not occur, and improvement is possible only during treatment. Depending on the degree of progression, continuous schizophrenia is further divided into forms.

Malignant (juvenile)

The disease usually manifests itself in childhood and adolescence. Main symptoms:

  • inappropriate, insensitive behavior towards others;
  • pathological mood variability;
  • disorganization of thinking.

Significant signs include illogical speech of a child or adolescent, pseudo-philosophical abstract thoughts. Others often view these symptoms as manifestations of puberty. Because of early start disease and the rapid development of negative symptoms, the prognosis is usually poor. The disease is characterized by rapid personality disintegration.

Simple

The disease may appear in adolescence. It is predominantly associated with negative symptoms including:

  • emotional numbness;
  • abulia;
  • anhedonia;
  • thinking disorder.

This form often tends to become chronic.

First symptoms:

  • lack of interest in school (work);
  • craving for loneliness;
  • sudden mood swings (irritability, short temper).

Other manifestations are usually present:

  • hypochondria;
  • logical thinking disorders;
  • depressed mood or unmotivated laughter;
  • disorders of higher emotions;
  • emotional dullness;
  • decreased will.

The disease can repeatedly occur under this picture or attacks under the guise of other forms.

Hebephrenic

This form is similar to the simple one, but develops faster. The disease begins in at a young age, which makes it difficult to distinguish from manifestations of puberty. Main manifestations:

  • amazing stubbornness;
  • anxiety;
  • impudence;
  • arrogance;
  • inappropriate jokes;
  • lack of shame;
  • disorders of thinking and concentration.

Paranoid (moderately progressive)

Paranoid schizophrenia is the type and form that is most common in most countries of the world. Characterized by relatively persistent delusions accompanied by hallucinations. The most common paranoid thought disorders include:

  • persecution mania;
  • pathological jealousy;
  • nonsense about transforming one's own body.

Disorders of perception are manifested by threatening, commanding voices, elementary auditory hallucinations. Olfactory, gustatory, sexual and other hallucinations are also present (visual are rare).

Schizotypal disorder (sluggish form)

This is a syndrome characterized by eccentric behavior and thinking, and affective abnormalities typical of schizophrenia. Occurs in adulthood - after 20 years. The disorder has a continuous course with varying intensity. There are no hallucinations, delusional states, serious problems in behavior. Sometimes the condition develops into overt schizophrenia. The danger of the disease lies in the absence of an expressive beginning, obvious development, as in other personality disorders. The syndrome is more common in people genetically related to schizophrenics. The condition is thought to be passed on from the woman (the mother), and is part of the genetic spectrum of schizophrenia.

Circular (periodic)

The periodic type of course is formed by mixed bipolar emotions of depression and hyperactivity with significant anxiety and fear. With hypomania, there is changeability of behavior and infantilism. Between individual acute attacks Long-term remissions are observed. But over time, depressive delusional symptoms and visual hallucinations arise.

Attack options:

  • Oneirophrenia. Characterized by distorted, dreamy perception, oneiric hallucinations. This condition is often observed during the initial manifestations of a general psychotic illness.
  • Schizocaria. Condition is typical rapid appearance psychotic symptoms that, over a relatively short period, greatly disrupt the patient's personality due to profound negative symptoms.

Paroxysmal-progressive (fur-like) type of flow

The form, which includes the main types of schizophrenia, is characterized by changes in the patient’s behavior. It manifests itself in his gradual closeness. A person loses vitality, his emotions align on one plane. Sometimes transient delusional thoughts and hallucinations may occur, but they do not have typical emotional severity and do not occupy a dominant place in the picture of the disease. The typical outcome of the disease is a gradual loss of a person from his life position: roles of son or daughter, student or employee, friend.

New typology of schizophrenia

In accordance with the symptoms in psychiatry, the following are distinguished:

  • negative symptoms– a consequence of the decrease or disappearance of any sign, slow motor skills, hypobulia, apathy, flat emotions;
  • positive symptoms - delusions, hallucinations, strange, restless behavior.

Negative symptoms are often caused by the disorder itself, while positive symptoms are a response to a decline in other abilities.

According to the predominance of symptoms, the disease is divided into:

  • type I;
  • type II.
  • positive schizophrenia (responds well to pharmacological therapy);
  • negative schizophrenia;
  • mixed schizophrenia.

How to recognize the disease?

The diagnosis can only be made by a specialist, a psychiatrist. Diagnosis is very difficult because the disease may have atypical development, complete nonspecific symptoms, making it easily confused with other mental illnesses.

Symptoms preceding the full manifestation of the disorder:

  • self-isolation (a person stops communicating with others);
  • "strange behavior;
  • inadequate personal hygiene;
  • sudden excessive enthusiasm for philosophical or religious ideas;
  • strange thoughts;
  • feeling persecuted by someone;
  • painful suspiciousness, touchiness;
  • drug abuse, especially marijuana and alcohol;
  • speech without emotion;
  • inability to concentrate.

Diagnostics

The diagnosis of schizophrenia is based on a complete psychiatric examination, medical history, physical examination, and laboratory tests.

Psychiatric examination

The doctor or psychiatrist asks the patient a series of questions about his symptoms and asks about psychiatric and family history of psychological problems.

History, physical examination

The doctor takes a personal and family history. A complete physical examination is performed to check for existing health problems that may be causing or maintaining the disorder.

Lab tests

There are no laboratory tests that can diagnose schizophrenia. Blood and urine tests can rule out other causes of the disease. The doctor may also order a CT scan to check the brain for abnormalities associated with schizophrenia.

Results

There is no specific test or method to detect schizophrenia. Diagnosis is based on observation of the patient and analysis of information received from him. Behavioral changes, anxiety, depression, and decreased self-care are signs of the prodromal stage of the disease. Typical symptoms, on which the diagnosis is based, include voicing one’s own thoughts, delusions, and hallucinations.

The continuous course of schizophrenia is characterized by a slow, inert long-term development with the gradual development of productive symptoms and cognitive impairment. Throughout the course of the disease, the negative symptoms of schizophrenia, noticeable even in the prodromal phase of the disease, gradually increase.

This type of course is not characterized by remissions, pronounced affective disorders and oneiric conditions.

The degree of progression of the process during the continuous course of schizophrenia can be different: from sluggish with mild personality changes to roughly progressive forms of malignant schizophrenia.

The age of onset of the disease significantly affects the characteristics of the course of continuous schizophrenia.

Sluggish schizophrenia Russian authors of the 70s of the twentieth century described it as a relatively shallow disorder of brain activity, manifested by the slow development of polymorphic, often rudimentarily represented by negative (some cases of a simple form) neurosis-like symptoms (obsessive, hypochondriacal, hysterical) or paranoid delusions. Psychopathic-like, affective states, symptoms of depersonalization, although they occur in this type of schizophrenia, are relatively weakly expressed here.

Personal premorbid personality traits seemed to sharpen in the first stages of the disease, then, as negative symptoms increased, they were erased and distorted. “Narrowing of personality” dominates “fall energy potential».

Moderately progressive or paranoid schizophrenia usually over the age of 25. At the first stage, the course of the disease is slow, and the duration of its initial period can vary - from 5 to 20 years.

At the onset there are short-term episodes of anxiety and unstable ideas about relationships. Suspicion, isolation, rigidity, and affective flatness gradually increase.

The manifest stage is characterized by delusions of persecution, physical impact, pseudohallucinations and the syndrome of mental automatism. Subsequently, schizophrenia progresses with a predominance of the hallucinatory-paranoid phenomenon, in some cases hallucinosis dominates, in others - delusions, in others - mixed states. In the first variant, at the onset of the disease, neurosis-like and psychopathic-like disorders are noted, in the second - paranoid ones. An undulating course and periodic exacerbations of symptoms are observed during the “transition of the disease from one syndromic stage to another (Elgazina L.M., 1958).

The first manifestations of the hallucinatory variant of moderately progressive schizophrenia can be considered verbal illusions with a rudimentarily expressed delusional interpretation. Subsequently, simple hallucinations appear, then true verbal hallucinations in the form of dialogue or monologue, in the latter case, often of an imperative nature. The first sign of the appearance of pseudohallucinations can be considered a commentary type of verbal hallucinations (“voices commenting on thoughts and actions”). The dynamics of Kandinsky-Clerambault syndrome are distinguished by a certain sequence: a symptom of openness; ideational, senestopathic, ideomotor, motor automatisms. In the clinical picture of the disease, signs of delusional depersonalization may occur. On last stage course, hallucinatory paraphrenia is observed with a fantastic content of delusion, probably of hallucinatory origin.

For the delusional variant of progressive schizophrenia, disorders of the delusional circle predominate throughout the course of the disease, and the syndromic dynamics of the course manifest themselves as a successive change of paranoid, paranoid and paraphrenic syndromes.

In the case of systematized paranoid delusions, the course is characterized by a sluggish character: a system of delusions is slowly formed, personality changes are characterized by a sharpening of premorbid features. Subsequently, against the background of “weakening emotional liveliness,” rigidity, pedantry, self-centeredness, isolation, and loss of interest in everything that goes beyond the delusional plot are noticeable. At the final stage of the disease, the expansion of the delusional system stopped, and delusional activity decreased. Against the background of general passivity, reasoning and thoroughness appeared. Transient exacerbations manifested themselves as intense affect, negative attitude to loved ones.

Malignant schizophrenia usually begins in childhood and adolescence, during puberty crises. It is not so common and accounts for no more than 5% of total number patients with schizophrenia.

Most cases of the malignant course of the disease should probably be attributed to “nuclear schizophrenia,” which is considered to be characterized by the rapid onset of “emotional devastation” with the disintegration of pre-existing positive symptoms.

Already at the first stage of the disease, a “stop” occurs. mental development": impossibility of perception new information, clear manifestations of negative symptoms (“decrease in energy potential”, “impoverishment of the emotional sphere”).

In the prodromal period of the disease, there may be complaints of heaviness in the head, confusion of thoughts, difficulty understanding what is happening or reading. “The patient eats enough, although slowly and without pleasure, ... but if he is not cared for, he rarely asks for food. He sleeps a lot, but at least dozing; if he is advised to take a walk, then he, although reluctantly, takes a walk. If they are asked about their condition, they slowly and quietly answer that they have a heavy head, and generally limit themselves to short answers” ​​(Chizh V.F., 1911).

Noteworthy is the noticeable change in family relationships. Patients who are passive outside the home are characterized by rudeness and callousness in the family. Patients usually show a sharply hostile attitude towards their father, and a tyrannical attitude towards their mother, often combined with a feeling of painful attachment.

The clinical picture of the onset resembles a pubertal crisis, but the distortion of its course is beyond doubt.

At the onset of the disease, patients develop special interests that are divorced from reality and unproductive, and a feeling of their own alteration arises. Attempts to understand what is happening are accompanied by symptoms of “metaphysical intoxication” (“philosophical intoxication”). Patients begin to read complex philosophical books, copying out large passages from them, while accompanying the latter with meaningless and absurd comments. In other cases, an extremely valuable passion appears for collecting things no one needs, the desire to visit the same places, and construct strange devices.

Manifestation appears “large” with polymorphic, syndromic incomplete productive symptoms: affective fluctuations, poorly systematized delirium, individual symptoms of mental automatism, flickering hebephrenic symptoms, catatonic symptoms.

Quickly, within 3-4 years, resistant end states are formed, characterized by negative symptoms, regression of behavior with signs of infantilism.

In the literature there are indications of the need to isolate various forms courses of malignant schizophrenia: simple, hebephrenic, lucid catatonia, paranoid hebephrenia.

Paranoid schizophrenia is a type of schizophrenia characterized by a predominance severe violations thinking in the form of paraphrenia, paranoid or paranoid types. Continuous paranoid schizophrenia is one of the most common forms of mental disorder.

Causes

The causes of schizophrenia are not fully understood. Researchers believe that the disease is biopsychosocial in nature. Its development is influenced by heredity, childhood mental trauma and education, alcoholism and drug addiction, socialization and human personality traits.

Symptoms

The basis of paranoid schizophrenia is gross violations thinking. Perception is distorted, and a specific, logically constructed, systematic and monothematic delirium is gradually formed.

Delusion is when the patient makes conclusions that do not correspond to reality. He is completely convinced that he is right, and his views cannot be corrected even by the most logical arguments.

Delirium is self-centered. The patient has thoughts and conclusions only regarding his personality. Delirium is emotionally charged. Thoughts evoke vivid emotions and excitement.

In popular culture, paranoia is associated exclusively with persecutory delusions. In reality this is not the case. Paranoia is based on any delusional ideas that may contain delusions of greatness, invention, exceptional origin, jealousy, poisoning, or contracting an incurable infection.

Paranoid schizophrenia develops slowly and has continuous type currents. Thinking disorders develop gradually:

  1. Initial (initial) period.
  2. Paranoid syndrome.
  3. Paranoid.
  4. Paraphrenic.
  5. Schizophrenic dementia.

The initial period is accompanied acute disorders perception and psychopathological syndromes. The most common syndromes are depersonalization-derealization, obsessive thinking, belief in the presence of an incurable disease, discomfort in the body of unknown location.

In the initial period, the patient becomes withdrawn and distrustful. The circle of communication and interests narrows, emotions become flat. It is difficult to evoke any emotion in him. The initial period may be accompanied by hallucinatory syndromes and neurosis-like conditions. The period lasts from 10 years.

The paranoid type of schizophrenia manifests itself as paranoid syndrome. This syndrome is characterized by the development of one delusional idea. The patient believes that he is a great reformer, an inventor, that he is being persecuted by political enemies, being watched at night, listening to his phone or intercepting his emails.

Severe delirium increases the patient’s volitional activity. For example, amid the delirium of ingenuity, a person can sit in a barn day and night and make a device for traveling through time or a device that will save all people on the planet from hunger. They visit administrative institutions with a request to issue a patent for the invention and use of their device, and pester loved ones with requests for help. This means that behavior is determined by the content of delusion.

Next stage - paranoid syndrome. It differs from paranoid delusions in non-systematic delusions, which concern many topics. Usually accompanied by true or pseudohallucinations. Syndromes in paranoid schizophrenia that occur at this stage:

  • Candidsky-Clerambault syndrome. It consists of pseudohallucinations, delusions of influence (poisoning, violence, persecution, deception, theft) and a feeling of “doneness”, when the patient believes that someone controls or reads thoughts in his head, controls his body or performs actions.
  • Hallucinatory-paranoid syndrome. Consists of hallucinations and delusions.

Signs of paranoid schizophrenia at the stage of paranoid syndrome:

  1. anxiety, agitation;
  2. distrust;
  3. alienation;
  4. feeling of approaching danger.

The next stage is paraphrenic syndrome (paraphrenia). This is severe disorganization of thinking. The plot (the content of nonsense) includes fantastic and absurd themes, completely divorced from reality. Against the background of paraphrenia, mood and volitional activity increase. The patient does everything to realize or follow a crazy idea. At the stage of paraphrenia, megalomania may develop - crazy idea, when the patient considers himself the ruler of the world, that he has a special mission in this life, he can save humanity from the invasion of extraterrestrial civilizations.

The last stage of development of paranoid schizophrenia is schizophrenic defect. This is the final state that is accompanied by schizophasia. It is characterized by a speech disorder in which the speech is grammatically correct, but its content is absurd and illogical.

Chronic paranoid schizophrenia may be accompanied by oneiric states and emotional disturbances.

Oneiroid is a disorder of consciousness in which the patient finds himself in a hallucinatory world of fantastic and absurd content, in which the patient participates. He can turn into a bird and fly over the craters of Mars; can turn into a drop of water, which freezes for a thousand years in the depths of the North Pole. The paintings are characterized by dreamlike experiences that are little intertwined with reality.

In the oneiroid state, the patient is completely disoriented and inactive. A typical symptom is “double presence”: the patient is in a world of fantastic hallucinations and at the same time understands that he is in a hospital bed.

Most Frequent emotional disturbances in paranoid schizophrenia – depression, hypomania, mania and dysphoria. Most often, patients with mental disorder are in a state high mood and physical activity.

Diagnostics

Criteria for diagnosing paranoid schizophrenia:

  • At least one of these symptoms:
    • “echo” thoughts, in which the patient believes that someone is putting thoughts into his head or reading them;
    • delusion of influence, when the patient believes that someone is controlling the body;
    • auditory hallucinations;
    • delirium of fantastic or absurd content that goes beyond the culture that is inherent to the patient; for example, the invention of a device to control the weather.
  • At least two of the following symptoms:
    • hallucinations are accompanied by delusions and last at least a month;
    • fragmentation, reasoning or spasmodic thinking, neologisms;
    • agitation or catatonia;
    • negative symptoms: flattening of emotions, decreased will, depression.

Differential diagnosis of paranoid schizophrenia is carried out with other forms of schizophrenia and some psychopathological conditions:

  1. Simple, catatonic and hebephrenic schizophrenia.
  2. Organic psychoses.
  3. Paranoid syndromes of organic origin.
  4. Bipolar affective syndrome, especially at the stage of mania.

Treatment

Treatment of paranoid schizophrenia aims to:

  • stop the development of psychopathological disorders;
  • achieve a medicinal effect;
  • stabilize the patient's condition;
  • rehabilitate the patient.

Treatment tactics for paranoid schizophrenia:

  1. Non-drug therapy: psychotherapy, sociotherapy, occupational therapy.
  2. Drug therapy. It is based on antipsychotics - drugs that relieve delusional and hallucinatory symptoms. In addition, antidepressants, anti-anxiety and sedatives are prescribed if delusions or hallucinations are accompanied by agitation and sleep disturbance.

Patients may have resistant paranoid schizophrenia. This means that after taking antipsychotics, delusions and hallucinations are not eliminated. In this case, monolateral electroconvulsive therapy is prescribed.

Schizophrenia is the third most disabling disease, after complete paralysis and dementia.

Prognosis: a third of patients partially recover and can be socially active. One sixth of patients recover completely, become full-fledged members of society and gain the ability to work. Women diagnosed with schizophrenia live several years longer. People with this disorder are at greater risk of suicide than others. About 30% of patients planned or attempted suicide.

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