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Schizophrenia is a very common severe mental illness. According to statistics, for every thousand people there are from four to six mentally ill people with a similar diagnosis. Of the many types of pathology, fur coat-like schizophrenia is often found.

The symptoms of schizophrenia are severe: delusions, hallucinations, autism, psychomotor disorders, affects. A progressive disease gradually destroys a person’s mind, reducing adequacy and breaking ties with the real world.

Based on the type of development, there are three main forms of schizophrenia:

Continuous: it includes malignant, sluggish and progredient (progressive).
Recurrent (periodic).
Paroxysmal-progressive (fur coat-like).

The continuously flowing form is not characterized by bright manifestations and bursts. The disease develops slowly, but remissions occur rarely or not at all.

The recurrent type of mental disorder, on the contrary, is characterized by well-defined bursts, followed by long-term deep remissions. It does not lead to profound changes in the individual’s psyche.

The fur-like form of the disease combines both paroxysmal and continuous types pathology. The term “fur coat” itself has nothing to do with a fur coat (as clothing), but comes from the German “schub”, which translates as “shift, step, push”.

The disease progresses in such a way that even during periods of weakening of the severity of symptoms (remission), the clouding of consciousness of the mentally ill continues to slowly worsen. The progress of the disease becomes obvious only with the next acute manifestation. At the same time, the doctor notes that the patient has new, previously unobserved symptoms, i.e. the pathology seemed to have “risen to the next level.”

Initially, such cases were diagnosed as exacerbations of a recurrent type of mental disorder against the background of an unexpressed, but continuous flow diseases. However, the subsequent attack revealed an increase in symptoms in many patients. Sometimes an attack (fur coat) added a personal shift, a mental breakdown to the clinical picture of the patient’s illness.

Thus, in psychiatry, a separate type of illness was identified - paroxysmal-progressive schizophrenia (also known as fur-like or fur-like).

With this type of illness, the mental defect can be different: from minor changes (of the sluggish type) to dementia (as in a malignant mental disorder).

Symptoms and course of the disease

In accordance with the phase of the disease, each stage is characterized by its own manifestations.

Symptoms of the initial phase and remission phase:

instability of the emotional background: the mood changes from cheerful and cheerful to depressed, depressed, while changes occur in waves, in cycles;
hypochondria: a person unreasonably suspects that he has serious, even fatal diseases;
hysterics, moodiness, irritability;
senestopathic disorders (pathology of sensations): the patient complains of painful and obsessive sensations of unknown origin - burning, tingling, twisting, etc.

Progression further worsens both changes in mood and features of depression. The surge is already characterized by the appearance of psychotic symptoms:

delusional ideas of various sizes;
obsessions, mania - persecution, presence of enemies around, greatness, etc.;
depersonalization: the patient ceases to feel like a single person, can perceive his thoughts or actions as if from the outside, loses the ability to control himself;
catatonic manifestations (characteristic psychomotor disturbances: obsessive movements, stupor, etc.);
oneiric disorders: hallucinations of absolutely fantastic content.

Of course, the variability of the clinical picture is much wider, and the peak moments pass with to varying degrees gravity. Gradually, from stage to stage, the development of negative personal changes in a mentally ill person is observed.

Classification of forms of fur coat-like schizophrenia

Depending on the progressive exacerbation of symptoms, the disease is divided into many subtypes:

with dominant features of depression;
the clinical picture is dominated by phobias and obsessive doubts (obsessions) against the background of depression;
manic;
with dominant depersonalization (feelings of change in one’s personality);
Kandinsky-Clerambault syndrome: automatisms of the psychotic type against the background of unclouded consciousness;
with most symptoms of a psychopathic type: nervousness, negativism, aggression against the background of loss of will;
catatonic and catatonic-hebephrenic type: delusions, hallucinations, catatonic disorders;
acute paranoid: paranoid symptoms combined with delusions and affective states.

Exacerbations with a predominance of catatonia are the most prolonged and severe.

Also, attacks with the main symptoms in the form of depersonalization and psychopathy have a long course.

Of particular danger is the manifestation of the disease in adolescence or adolescence, in this case it often takes on a malignant nature. Seizures suffered in childhood often lead to noticeable personality defects.

The frequency of bursts also varies from person to person. Often patients with the fur-like form of the disease experience only one exacerbation during the entire period of the disease, or they occur quite rarely: once every two or three years.

Schizophrenia, which manifests itself at a late age, is usually classified as fur-like. For a complete clinical picture, it will be important for the psychiatrist to track the entire pre-manifest period, although it may last for decades.

In general, the course of the fur coat type is multivariate, so psychiatry usually finds it difficult to give a clear prognosis to a sick person. In medical practice, there are cases of sustained relief and improvement in the condition of patients after many years of severe catatonic-delusional attacks. And the opposite stories, when the clinical picture showed only minor surges suffered in adolescence, then a stable long-term remission, but in the end - a strong re-exacerbation is recorded in adulthood or old age of the patient.

Causes of development and diagnosis

The causes of schizophrenia are largely unknown. Among the main theories of the occurrence of pathology, scientists identify: brain dysfunction, heredity, stress factors in human life, disorders acquired in the prenatal period of development, as well as intoxication (drug addiction, alcoholism).

Additional Information. It has been noted that women are more likely to suffer from milder forms of the progressive type of the disease, while men are more likely to suffer from severe forms. Diseases associated with clouding of reason hit men harder: they are more likely to lose their jobs and property, and it is more difficult for them to adapt after an exacerbation. In women, the disease usually manifests itself milder and less noticeable to others. After the crisis, it is easier for them to restore full social activity and personal life.

Difficulties in diagnosing this particular type of disease initial stage lie in the similarity of a number of symptoms with various neuroses, psychoses and psychopathy. However, over time, gradual pathological changes in the patient's personality become more obvious.

Treatment and prevention

Coat-shaped schizophrenia (like other types of pathology) is treated with a combination of a course of medications and psychotherapy sessions. Naturally, exacerbations of the disease require mandatory hospitalization in a psychiatric clinic.

The timing of the end of inpatient treatment cannot be adjusted to the wishes of the patient or his family members. Doctors need to achieve a stable result, so it is naive to expect that the patient will be discharged a few days after cupping acute symptoms and slight improvement.

Unfortunately, sometimes quality treatment for a mental disorder requires the victim to remain in the hospital for many months or even many years. This will inevitably lead to its rupture later social connections, loss of adaptation to the surrounding world.

Schizophrenia: treatment and prognosis of effectiveness. Modern medical supplies, possibility of therapy folk remedies and homeopathy. Consulting psychotherapist highest category, candidate medical sciences Galushchak A.

Drug treatment necessarily includes:

course of antipsychotics: these drugs reduce negative symptoms, and also stop psychosis and the progress of pathology;
antipsychotics as maintenance therapy.

I would like to note the importance special treatment to the man who passed psychiatric treatment. Close people can provide him with an invaluable service, surrounding him with care, warmth and understanding. You also need to ensure that the patient follows the principles of a healthy lifestyle and takes all prescribed medications on time. For mental stability, a friendly atmosphere in the family and complete absence stress.

Please note that a mentally ill person himself is usually not aware of his illness, perceiving everything that happens to him as normal. Close people must convince him to see a doctor. Sluggish forms of the disease can be especially dangerous because they create the illusion that there is no problem serious enough to see a doctor. This is fraught with the development of pathology, which could have been avoided.

Despite the complexity of such a disease as paroxysmal schizophrenia, timely treatment significantly reduces the manifestation of symptoms and increases the time of remission. And although the nature of this mental disorder is still largely unknown, today many patients have a chance to live a full life.

This form of progression in childhood and adolescence has not been sufficiently studied. M.I. Moiseeva (1969) found that schizophrenia with delusional manifestations in childhood and adolescence, as in adults, can have a continuously progressive course.

The onset of the disease is gradual, expressed in increased emotional disorders■(emotional coldness, weakening of contacts and interests), mental rigidity. In preschool and junior" school age ideas of attitude predominate, "which are expressed in persistent suspicion and distrust, a "delusional mood", which, however, does not acquire a complete verbal form. Patients claim that children treat them badly, "walk in a crowd, conspire to beat", "not with who cannot be friends, they will take notebooks, books, etc. Often already in preschool age a “delusional mood” arises in relation to the parents, towards whom the child shows hostility and distrust. Gradually, a tendency to expand delusions and involve new people in the sphere of delusional constructions is revealed. Subsequently, individual auditory hallucinations, episodic rudimentary mental automatisms, and even later, rudimentary auditory pseudohallucinations appear.

In childhood, as well as in adults, two variants of paranoid schizophrenia can be distinguished - with a predominance of delusional or hallucinatory disorders. In the delusional variant, at the initial stage, delusional fantasies of a paranoid nature are noted in the form special games and educational interests. In the hallucinatory variant, the initial stage is determined by excessive figurative fantasy with a pseudohallucinatory component. In cases of the delusional variant, the disease may begin at an early age (2-4 years) and progress slowly. Children often exhibit premature intellectual development - by the age of 2 they have a large vocabulary, and by the age of 3-4 they can sometimes read. Stable one-sided interests of an overvalued nature are revealed early. Initially, this manifests itself in the desire to ask special (“inquisitive”, “philosophical”) questions, in stereotypical games with schematization of game objects (selection of teapots, shoes, etc.), in a penchant for unusual collecting (soap, bottles, locks).

“Inquisitive”, “philosophical” questions are not random in content, they are cognitive in nature and associated with a specific idea. They differ from the “stage of questions” of a healthy child by an excessive interest in the abstract, which is not typical for this age, and, most importantly, by a close connection with stable, monotonous ideas. According to K. A. Novlyanskaya (1937), in children with schizophrenia, the period of “inquisitive questions” is delayed for a long time, which with age take on the character of extremely valuable ideas. Early manifestation The disease is a pathology of gaming activity. From 2-3 years old, stereotypy in games is noted. For example, a child constantly plays with wires, plugs, sockets, not paying attention to toys. At the end of preschool and primary school age, maintaining an increased interest in electrical equipment, he begins to redraw electrical circuits and reviews physics and electrical engineering textbooks. Obsession with such one-sided interests is typical of paranoid states.

At school age, one-sided interests increasingly resemble paranoid states in adults: there is a desire to logically develop an isolated idea, a tendency to detail in thinking. At primary school age, elements of delusional depersonalization arise, and patients transform into images of their hobbies. Children imagine themselves as a “clockwork”, “trolleybus” and behave according to their experiences. Criticism of one's behavior is impaired. As the disease worsens, fragmentary ideas of persecution, poisoning, and, in some cases, ideas of greatness arise. As the progression of the disease increases, more defined delusional ideas develop

persecution and influence. Just like the delusional version of paranoid schizophrenia in adults, perceptual disorders are rarely observed. Some patients experience rudimentary auditory hallucinations.

In the hallucinatory (or hallucinatory-delusional) variant of paranoid schizophrenia, the disorder predominates from the very beginning sensory knowledge, the leading place in the clinical picture is occupied by excessive figurative fantasy. As mental automatisms increase, fantasies become more and more pronounced involuntariness, visual pseudohallucinations and dream experiences are added. The day of development of mental automatisms ends with the appearance of delirium:! mastery, depersoyalization-> tion, i.e. the formation of the syndrome;) Kandinsky-Clerambault. Pathological fantasies and mental automatisms are figurative in nature (visual: pseudohallucinations, dream experiences, figurative delusions). The onset of the disease most often occurs before school age. Excessive imaginative fantasizing very early begins to be accompanied by visualization of ideas, pseudohallucinations with a feeling of influence. A certain sequence of occurrence of these phenomena in the same patient is characteristic. Thus, at the beginning of the disease, the leading ones in the clinical picture are excessive figurative fantasies with visualization of ideas; later, especially during an exacerbation of the disease during the second age crisis (6-7 years), dreamlike experiences, visual pseudohallucinations, violent thinking arise, and, finally, in school age - delusional disorders(often simultaneously with pseudohallucinations that carry the experience of influence). Over time, delusional ideas expand, delusions of relationship, persecution, and delusional depersonalization arise (“two people live in the head” - the child sees them). In other patients, rudimentary paraphrenic disorders occur at a later stage of the disease. At the same time, fantastic statements acquire the character of greatness (“I will become a god, a king,” etc.). These ideas become persistent, criticism disappears, behavior begins to correspond to painful experiences. Just as at the initial stage, during the development of figurative fantasies, and subsequently, during the development of delusional experiences, delusional depersonalization and paraphrenic disorders, all of these disorders are not so much of an ideational nature as of the nature of figurative ideas. "With the advent crazy ideas the process becomes more progressive.

Continuously progressive, paranoid schizophrenia in adolescents has its own

vegetable clinical features. Ideas of relationship are usually combined with dysmorphophobic delusional ideas, ideas of persecution, influence. In some cases, one can note a tendency towards systematization of delusions: patients try to logically substantiate delusional ideas. Puberty is characterized by the formation of a peculiar delusional worldview of antagonism, hostility towards people in general: “you can’t trust people, don’t expect good things”, “the kids will let you down”, etc. Antipathy often arises towards close people, especially the mother. Teenagers become angry and aggressive towards their parents, and often try to leave their parents' home. Others, with the emergence of delusional ideas, become more withdrawn, completely withdraw from the children's group, avoid people, do not go out into the street, and cover the windows. As the disease progresses, delusional ideas of poisoning and exposure arise. IN close connection With delusions of influence are the phenomena of ideational, motor and sensory automatisms. Patients say that thoughts come against their will, they feel their influx, begin to mentally “respond” to their thoughts, complain that all their actions and movements cease to depend on them, that now they are “like an automaton” *, with their “language , someone else says with his lips.”

The most common plot of delusions in adolescents is the idea of physical deformity (dysmorphophobia). With a continuously progressive course, dysmorphophobia becomes an integral part of the delusional hypochondriacal system (P. V. Morozov, 1977). The content of patients' experiences is often pretentious and absurd. Patients are convinced that their calves are too thick and they cannot retain intestinal gases. Teenagers look for the causes of their defects, actively strive to eliminate them, seeking operations, sometimes “operating” on themselves. They often experience various painful sensations in those parts of the body that they consider ugly. At later stages of the disease, after 10-15 years, systematized hypochondriacal delusions usually develop with the conviction of the presence of a severe somatic illness, obsession and logical development of the delusional system. A paranoid or hallucinatory-paranoid state occurs with Kandinsky-Clerambe syndrome and the dominance of hypochondriacal ideas.

In general, continuously progressive paranoid schizophrenia in childhood and adolescence is characterized by the absence of a tendency to spontaneous remissions, a gradual expansion of delusional and hallucinatory disorders, the addition of mental automatisms, as well as an increase in negative manifestations - emotional coldness, mental rigidity, a drop in productivity, and loss of previous interests.

Malignant current schizophrenia in children and adolescents manifests itself, as a rule, either during the first age crisis (2-4 years) or at puberty. The clinical patterns of malignant schizophrenia include: 1) the onset of the disease with negative symptoms;

2) progressive course; 3) polymorphism of productive symptoms when they are amorphous; 4) high resistance to therapy; 5) a tendency to the formation of severe final states (R. A. Nadzharov, 1905; M. Ya. Tsutsulkovskaya, 1968; Yu. I. Polishchuk, 1965; T. A. Druzhpshsha, 1970).

In children of early age, malignant schizophrenia was first described by G. II. Simeon (1948), later it was studied by L. Ya. Zhsalova (19(57), I. L. Kozlova (1967, 1976) etc. Comparative learning of malignant juvenile schizophrenia and malignant schizophrenia in young children reveals the general patterns noted above. Cases of malignant schizophrenia in young children account for approximately 4 times the number of patients with schizophrenia of this age. The initial period is short (from 1 year to 17 years), characterized by a predominance of negative symptoms in the form of a rapid decline in mental activity, motivation, suspension mental development. Often 1 these children, even before the manifestation of the disease, from the end of the first or at the beginning of the second year of life, changes in behavior are noted - weak interest in games, a passive reaction to affection, lack of desire to communicate. Mental development - from 1 to 17 years of age can occur in a relatively timely manner. Children begin to walk on time, their first words sometimes appear before the age of 1 year, and by the age of two they have a large passive vocabulary. The disease often begins at the age of about 2 years (earlier than with sluggish schizophrenia). Children, having a large vocabulary, either stop using them altogether, or utter peculiarly constructed phrases consisting of 2-3 words and having an impersonal form (“give me a drink”, “go for a walk”, etc.). They disappear attachment, children react weakly to the departure and arrival of the mother, become unaffectionate. Noticeable is marked passivity, lethargy, lack of desire to play with peers, lack of interest in toys. Early on, a tendency to monotonous games appears, which are in the nature of "motor stereotypies (threading a rope in car, waving the same toy, tapping on a box, toy, etc.).

Despite the severity of negative symptoms (emotional changes, autism, passivity), as well as a slowdown in the rate of mental development, the latest web development

should. Children slowly acquire new words, their phrasal speech begins to form. With little interest in the environment, the child may show some emotional vulnerability* and give a painful reaction to being placed in a nursery or to a change in environment. At the age of 242-3 years, the progression of the disease increases: contact with others is sharply disrupted,

the child stops answering questions and reacting to separation from parents, previously favorite games become more monotonous and poorer in content. Gradually, rudimentary productive disorders appear: episodes of fear and, possibly, visual hallucinations(the child, pointing to the corner, asks in fear: “Who’s there?”). Catatonic and hebephrenic manifestations quickly occur.

Depending on the predominance of one or the other, two variants of malignant schizophrenia in young children can be distinguished: 1) a variant with a predominance of catatonic disorders; 2) a variant in which hebephrenic manifestations come to the fore. The first option is much more common. In this case, mutism, echolalia, verbigeration, motor retardation, short-term freezing, mannerisms, pretentious movements, anxiety, impulsiveness, aimless running in circles (“manege running”), monotonous jumping, stereotypical movements, and inadequate laughter gradually appear. Symptoms of motor excitement prevail over stuporous phenomena. In the department, the behavior of these children is extremely monotonous. They are always aloof from the children's group, do not strive for contact with the staff, and do not respond to affection. Their attention is attracted only by a short time. Children do not demonstrate neatness skills and are hand-fed. Speech is relatively intact; regardless of the situation, the child can spontaneously repeat individual phrases. In unique games, the ability for complex and subtle actions is often revealed. Unlike mentally retarded children and patients with organic dementia, they exhibit the ability to perform complex actions, a peculiar desire to systematize objects by shape, color, etc.

In the second option (with a predominance of hebephrenic disorders), at the first stage of the disease, psychopathic disorders with hebephrenic features are more often detected, and during the period of a developed disease, more pronounced hebephrenic symptoms are detected. Psychopathic-like disorders, already at the initial stage, are accompanied by changes characteristic of schizophrenia - passivity, decreased motivation, a tendency to stereotypes, pronounced negativism, resistance to any external influence, inappropriate actions, an abundance of neologisms, a peculiar desire

distort words. As the disease progresses, the phenomena of hebephrenic excitation in the form of motor restlessness with euphoria, foolishness, the desire to take unusual positions, and pronounced mannerisms become more and more pronounced. The child suddenly stands on his head, spreads his legs wide, etc. Impulsive actions are typical: aimless running, jumping, aggression. Over time, agitation, intermittent speech, stupidity, and the desire for neologisms and rhyming intensify.

Fur-like schizophrenia is the most common among all forms of schizophrenia. The essence of the paroxysmal-progressive type of dynamics of schizophrenia lies in the combination of two variants of the course - continuous and periodic.

In the initial period, negative personality changes typical of schizophrenia appear and gradually progress, and in some cases, productive symptoms in the form of obsessions, depersonalization, overvalued or paranoid ideas. Next, manifest and subsequent attacks occur in the form of transient, qualitatively new disorders in relation to the permanent symptoms.

Attacks of fur coat-like schizophrenia are distinguished by particular clinical diversity. There are acute paranoid, acute paranoid, catatonic-hebephrenic, catatonic-depressive, depressive-hallucinatory, depressive-obsessive and other attacks. Each attack is accompanied by a personality shift, a deepening of negative personality changes and an increase in permanent productive impairments.

In some patients with fur-like schizophrenia, negative personality changes and chronic productive disorders progress slowly and in the intervals between attacks.

The degree of progression of fur coat-like schizophrenia and the depth of the developing mental defect vary significantly. In some cases, fur coat-like schizophrenia is close to the malignant form and ultimately ends in the final state ( schizophrenic dementia), in others, due to the low severity of progressive tendencies, it is close to sluggish schizophrenia and leads to a shallow personality defect. Most cases of fur coat schizophrenia fall somewhere between these extremes.

Special forms of schizophrenia. The essence of paranoid schizophrenia lies in the emergence and long-term existence of systematized delusions. In some patients, delirium develops acutely - like an insight, in others gradually - on the basis of previous highly valuable ideas. Clinical manifestations paranoid schizophrenia have significant similarities with the paranoid stage of paranoid schizophrenia described above.

The difference is that with paranoid schizophrenia, the picture of the disease throughout its entire duration is limited to systematized delusions. There is no transition from paranoid to paranoid syndrome.

Paranoid schizophrenia is manifested by delusions of persecution, physical disability, hypochondriacal, inventive, reformist, religious, litigious delusions. In many patients, delirium is monothematic.

Pathological ideas progress extremely slowly. After decades, the delusion may undergo a partial reverse development, remaining in the form of residual or encapsulated (largely lost relevance) delusional ideas. Negative personality changes typical of schizophrenia cannot always be identified.

Febrile schizophrenia (fatal catatonia, hypertoxic schizophrenia) is called acute attacks oneiric catatonia within the framework of recurrent and paroxysmal-progressive schizophrenia, accompanied by hyperthermia and other somatic disorders. Along with catatonia in the form of stupor or agitation, rises in body temperature up to 38–40 °C occur for up to 2 weeks. The temperature curve does not correspond to typical temperature fluctuations in somatic and infectious diseases. Dry mucous membranes, skin hyperemia, bruising, sometimes bullous rashes, and ulceration of the skin are noted.

In the most severe cases, at the height of the attack, oneiric stupefaction is replaced by amentia-like with deep disorientation, incoherent speech and monotonous motor excitation, limited to the bed. The appearance of choreiform hyperkinesis is possible.

Remission usually occurs after a few weeks. In rare cases, death can occur. Sometimes the patient suffers several attacks of febrile schizophrenia.

Treatment and rehabilitation. In the treatment of patients with schizophrenia, almost all methods of biological therapy and most methods of psychotherapy are used.

Biological therapy. Leading place in biological treatment schizophrenia belongs to psychopharmacotherapy. The main classes of psychotropic drugs used are antipsychotics and antidepressants. Drugs of other classes are used less frequently.

For malignant schizophrenia, high doses of the most powerful antipsychotics with a general antipsychotic effect are prescribed in order to stop the progression of the disease and mitigate its manifestations. However, therapy, as a rule, is not effective enough.

For paranoid schizophrenia, neuroleptic antipsychotics (haloperidol, triftazine, rispolept, azaleptin, fluanxol) are used. After improvement of the condition and partial reduction of hallucinatory-delusional disorders, long-term (usually many years) maintenance therapy is carried out, often with the same drugs, but in smaller doses. Injection depot forms of antipsychotics (haloperidol decanoate, moditen-depot, fluanxol-depot) are often used. In the first 2 years after the development of hallucinatory-paranoid disorders, insulin comatose therapy is possible (with the consent of the patient or his relatives). They are particularly resistant to therapy paranoid syndrome and chronic verbal hallucinosis.

Long-term use of antipsychotics often leads to patient intolerance to drugs, mainly in the form of neurological side effects and complications (neurolepsy, tardive dyskinesia). In these cases, antipsychotics should be used that do not cause or almost do not cause side neurological effects (Leponex, Rispolept, Zyprexa).

In recurrent and paroxysmal-progressive schizophrenia, the choice of drugs is determined by the syndromic structure of the attacks. Patients with depressive attacks are prescribed the most active antidepressants (amitriptyline, melipramine, anafranil), which are usually combined with low doses of antipsychotics that do not have a depressogenic effect (triftazine, etaprazine, rispolept).

In patients with depressive-paranoid conditions, the same combination of drugs is used, but the doses of antipsychotics should be significant or high. If the above antidepressants are ineffective, Zoloft, Paxil or other thymoanaleptics from the group of selective serotonin reuptake inhibitors can be prescribed. Manic episodes are most often treated with haloperidol in combination with hydroxybutyrate or lithium carbonate. The same drugs are used in patients with manic-delusional states. For oneiric catatonia, antipsychotics with an inhibitory effect are prescribed. If antipsychotics are ineffective, electroconvulsive therapy is indicated.

In patients with psychomotor agitation, injectable neuroleptics with inhibitory properties (clopixol-acufaz, aminazine, tizercin, haloperidol, topral) are used in the structure of various attacks.

Treatment of febrile schizophrenia, if possible, is carried out in intensive care units. Active detoxification is used, including hemosorption, hemodesis, and symptomatic therapy and sometimes aminazine. In cases of particularly severe condition (according to vital indications), ECT is performed.

In interictal intervals, outpatient therapy is carried out to stabilize remission and prevent new attacks. Often the same drugs are used as during attacks, but in smaller doses. At high specific gravity affective disorders in the structure of attacks are prescribed for long time mood stabilizers (lithium carbonate, finlepsin, sodium valproate).

Drug treatment of sluggish schizophrenia is carried out with a combination of small or medium doses of antipsychotics or neuroleptics with a milder effect (Sonapax, neuleptil) and antidepressants.

In many cases, tranquilizers are also prescribed. For sluggish schizophrenia with a predominance of phobias and obsessions, tranquilizers are prescribed - sedatives (alprazolam, phenazepam, lorazepam, relanium), high doses of antidepressants and moderate doses of antipsychotics.

Psychotherapy. Psychotherapy occupies an essential place in the treatment of patients with schizophrenia.

In the presence of severe psychotic symptoms (paranoid schizophrenia, psychotic attacks of recurrent and fur-like schizophrenia), patients need the participation, encouragement, and support of a doctor. Demonstration of a skeptical attitude towards delusional judgments and attempts to refute them are unproductive and only lead to disruption of contact between the doctor and the patient. Explanations of what statements and forms of behavior of the patient are assessed by others as painful are justified. Useful family psychotherapy(psychotherapeutic work with the patient’s relatives, aimed at forming the correct attitude towards his painful statements and behavior, at eliminating intra-family conflicts that often arise as a result of painfully changed behavior of a family member).

For non-psychotic levels of disorders (remission of paroxysmal schizophrenia, sluggish schizophrenia), systematic psychotherapy, mainly rational (cognitive) and behavioral, is indicated.

Techniques of stimulating and distracting psychotherapy are used. Special techniques are used aimed at eliminating certain disorders, for example, functional training for transport phobias.

Methods such as hypnosuggestive psychotherapy, autogenic training, psychoanalytic psychotherapy is used in patients with schizophrenia to a limited extent due to the risk of deterioration of the patients’ condition and low effectiveness.

Social rehabilitation is indicated for almost all patients with schizophrenia (the exception is patients with preserved ability to work and sufficient social adaptation).

Even with chronic psychotic symptoms, a deep personality defect with complete disability, the systematic use of social rehabilitation measures in combination with pharmacotherapy and psychotherapy allows a number of patients to partially restore basic self-care skills and involve patients in simple work activities.

In such cases, the process of social rehabilitation is multi-stage in nature. It often begins during the hospitalization period with the involvement of patients in performing simple household tasks.

Next, patients systematically perform simple work in the department, and then in occupational therapy workshops at the hospital. After discharge from the hospital, they continue to work in occupational therapy workshops, moving on to increasingly complex operations.

With a successful rehabilitation process, it is possible to return to work that does not require high qualifications, in special enterprises for the mentally ill, or even in general production conditions. To do this, patients have to be taught new work skills that are accessible to their mental state.

For sluggish schizophrenia, recurrent schizophrenia with rare attacks, properly organized social rehabilitation in combination with treatment, it often allows you to maintain or restore your pre-illness professional, family and social status.

Paroxysmal-progressive schizophrenia is a combination of a continuous and paroxysmal course or a paroxysmal course of the disease with a variety of acutely and subacutely developing psychotic states, varying degrees of progression and corresponding varying severity of mental defect and personality changes. Initially, cases now classified as paroxysmal-progressive schizophrenia were considered as an expression of a combination of a sluggish continuous course and attacks of recurrent schizophrenia. However, further research has shown that the range of disorders reflecting both a continuous nature disease process, and attacks, goes beyond such ideas. It was found that, although in some cases the disease is exclusively paroxysmal in nature, the degree of progression of the disease process in this form of course is quite pronounced and varies widely, leading in some patients to a rapid increase in the defect from attack to attack, and in others to a relatively mildly expressed personality changes. This form of schizophrenia is often called fur coat-like (from German. schub - shift). This means that after each attack a personal shift occurs, a “break” in the personality. However, not every attack in this sense can be qualified as a fur coat, because after some attacks, gross distortions of the personality do not develop. Depending on the characteristics of the clinical picture and the degree of progression of the disease, paroxysmal-progressive schizophrenia is divided into several variants. One of them is similar to juvenile schizophrenia with a malignant course, the other - with paranoid schizophrenia, the third - with sluggish; In addition, schizoaffective paroxysmal-progressive schizophrenia is distinguished. The above division confirms the intermediate position of paroxysmal-progressive schizophrenia between continuous and recurrent. Malignant paroxysmal-progressive schizophrenia is close in its clinical manifestations to juvenile malignant continuous schizophrenia and consists of signs of a continuous course and attacks developing against its background. As with juvenile malignant schizophrenia, the disease begins gradually - with a drop in energy potential, manifested by a decrease in academic performance, inactivity and loss of previous interests, as well as increasing emotional deficiency and the development of rudimentary depersonalization, dysmorphophobic, catatonic disorders. Already in the initial period of the disease, affective disorders appear, characterized by atypia and “dullness” of affect. We are usually talking about hypomanic and subdepressive states. During this period, psychopathic-like disorders are identified. As the disease progresses, hypomanic states increasingly lose the features inherent in hypomania: cheerfulness is replaced by euphoria with foolishness, there is no desire for activity, disinhibition of drives, an unmotivated feeling of hostility towards loved ones, and individual ideas of relationship appear. In subdepressions, attention is drawn to lethargy, a feeling of aversion to any type of activity, irritability, rudeness, a tendency to abuse alcohol, and impulsive suicidal attempts. Both in states of hypomania and subdepression, patients occasionally experience rudimentary catatonic disorders in the form of stereotypy, grimacing, and freezing in monotonous positions. Often, affective disorders acquire a continual character with a continuous change of hypomanic and subdepressive states. Manifestation of the disease usually occurs at the age of 12-14 years, 2-2.5 years after the beginning of the described initial period, i.e. against its background. Manifest psychoses often resemble psychoses that develop during continuous juvenile schizophrenia. In this case, they are characterized by extreme polymorphism and lack of development of symptoms: atypical affective disorders are combined with fragmentary delusional ideas of relationship, persecution, hallucinatory and pseudohallucinatory disorders, signs of mental automatism, catatonic manifestations in the form of substuporous episodes, alternating with excitement with impulsiveness or foolishness. It is also possible to develop catatonic psychoses with retardation, turning into a persistent substupor with rudimentary ideas of relationship, individual hallucinations, pseudo-hallucinations. After the manifest, i.e., the first attack of the disease, pronounced signs of schizophrenic personality changes are revealed. Remissions are characterized by short duration, instability and the presence of rudimentary symptoms of the delusional and catatonic registers. After 2-3 attacks of the disease, social maladjustment and rough schizophrenic defect. Unlike juvenile malignant continuous schizophrenia, patients with this form of the disease can be adapted to simple types of work. They have an awareness of their own change. Selective attachment to loved ones is also characteristic. Sometimes one has to observe fairly stable and long-lasting remissions with varying degrees of personality changes. Paroxysmal-progressive schizophrenia, close to paranoid, It is distinguished by a fairly pronounced polymorphism of attacks. Clinical manifestations of the disease vary. In some cases, we are talking about the development, against the background of a continuous course of paranoid disorders or interpretive delusions, of attacks with a predominance of delusional and hallucinatory disorders in their picture, in others, the disease manifests itself exclusively in the form of attacks (acute conditions with paranoid or interpretive delusions are also possible) . The onset of the disease, i.e., the occurrence of the first attack of the disease, may be preceded by personality changes, which usually develop after erased attacks of the disease, or slowly increasing personality changes in the form of smoothing out the patient’s character traits or, conversely, the appearance of unusual character traits. There is a drop in mental activity, a narrowing of the range of interests, and a leveling of emotional reactions. It is possible to develop mildly expressed affective disorders: hypomania and subdepression with a predominance of psychopathic-like manifestations in the picture, which cannot always be recognized as affective disorders. The immediate manifest attack of the disease is preceded by the development of paranoid disorders or interpretive delusions with varying degrees of systematization and, as a rule, with mildly expressed personality changes. The attacks in the picture of the described variant of paroxysmal-progressive schizophrenia are characterized by acutely developing interpretative (paranoid) delusions, hallucinosis, Kandinsky-Clerambault syndrome, and paraphrenia. Acute seizures with interpretative delusions are characterized by a gradual or rather acute development of more or less systematized delirium, arising against the background of causeless internal tension, vague anxiety, restlessness, and delusional mood. The emerging mono- or polythematic delirium subsequently tends to expand and develop episodes of sensory delirium in the form of staging phenomena. The occurrence of sensory delirium is usually preceded by the appearance of anxiety and fear; resolution of the acute condition is accompanied by the development of a reduced background mood with incomplete criticism of not only the period of sensory delirium, but also interpretive delirium. Attacks of acute hallucinosis develop against a background of low mood with anxiety, wariness, individual ideas of relationship and persecution. First, calls arise: the patient hears swear words spoken to him. Next, hallucinosis develops with commentary and imperative content, sometimes transforming into pseudohallucinosis. Hallucinosis can develop at the height of an attack and with symptoms of acute paranoid: the condition is characterized by significant kaleidoscopicity and variability; either sensory delirium or hallucinatory disorders come to the fore in the picture of the syndrome. Seizures with acutely developing Kandinsky-Clerambault syndrome usually develop against the background of affective disorders of a manic or depressive nature. The phenomena of mental automatism predominate - individual ideational disorders up to a total mastery syndrome or pseudohallucinatory disorders with the possibility of further development of pseudohallucinatory delusions. Often the phenomena of mental automatism are closely intertwined with interpretative delirium. Sometimes the development of mental automatisms in the picture of interpretative delirium is accompanied by a change in the plot of the latter. An attack with a picture of acute paraphrenia characterized by the presence of antagonistic (fantastic) delusions with ideas of greatness and a picture of pseudohallucinatory paraphrenia. The occurrence of attacks of various psychopathological structure, their modification occurs in accordance with the general patterns of changing syndromes characteristic of paranoid schizophrenia, i.e., after an attack with interpretive delusions, an attack with hallucinosis or Kandinsky-Clerambault syndrome develops, and then an attack with a picture of acute paraphrenia. The quality of remissions after these attacks varies. It is determined by the severity of personality changes and the presence of residual psychotic disorders. The nature of personality changes varies from mild to significant with a drop in mental activity and social maladjustment. During periods of remission, there are often rudimentary psychopathological disorders of the delusional and hallucinatory register, and there is often no full criticism of the psychosis experienced. Unfortunately, there is no definite data on the prognostic significance of attacks of various psychopathological structures. Paroxysmal-progressive schizophrenia, close to sluggish , is a variant of the disease in which disorders reflecting the continuous nature of the process are characterized by obsessions, depersonalization phenomena, hypochondriacal, senestopathic and hysterical disorders. A manifest attack may be preceded by cyclothyme-like fluctuations, often of a continuous nature, which are, as it were, a prototype of subsequently developing developed affective attacks. Attacks that occur against this background are usually affective - more often depression and less often mania. With significant severity of affective disorders during an attack, disorders reflecting the continuous nature of the process do not occupy the main place in the patient’s condition, and in cases of mildly expressed attacks affective disorders the intensity of such disorders is more pronounced: patients are “involved” with obsessions, senesto-hypochondriacal and other experiences. Sometimes double affective attacks develop (depression-mania, mania-depression). Along with cases when attacks acquire the character of a cliché, with this variant of the course of schizophrenia, their structure may become more complex with the development of sensory delirium. After suffering one or several attacks, the picture of the disease stabilizes and consists of residual neurosis-like symptoms and personality changes, which gives grounds to qualify this stage of the disease as residual schizophrenia. The presented division of paroxysmal-progressive schizophrenia is not absolute. This concerns primarily the relationship between disorders that reflect the continuous nature of the process and the attacks that occur against their background. It is known that against the background of deficiency symptoms reminiscent of “simplex syndrome”, not only attacks similar to the psychoses observed in juvenile continuous malignant schizophrenia can develop, but also affective and affective-delusional ones. The same can be observed in cases where the disorders are interpretive or paranoid delusions. Against the background of neurosis-like symptoms, attacks develop, the clinical picture of which is characterized by hallucinosis or acute paraphrenia. In other words, the described tropism certain types attacks to various options continuous flow is not required. Analysis of attacks that differ in their psychopathological picture shows that they also have significant general features. First of all, we are talking about the heterogeneity of the structure of attacks, which concerns, in particular, the dissociation between poignant picture sensory delirium and the outwardly ordered behavior of the patient, as well as a kind of inconsistency of the disorders with each other. This means that expansive paraphrenia with an elevated background of mood can be combined in a patient with hypochondriacal delirium or painful senestopathies. Noteworthy is the lack of a critical attitude towards the experienced attack, despite the patient’s sufficient safety - the absence of pronounced personality changes and reduction in energy potential. It should also be noted the prognostic significance various types seizures. Unfortunately, there are still no criteria that would with a significant degree of probability allow prognostic considerations to be made based on the psychopathological structure of the attack, and nevertheless, the nature of the attacks observed in paroxysmal-progressive schizophrenia allows us to generalize the corresponding clinical observations. The manifest attack of oneiric catatonia suffered by the patient does not in all cases indicate a recurrent course of schizophrenia. Often, after such an attack, the prognosis, at first glance, is quite favorable, may develop unusual for a recurrent course. pronounced changes personality, which gives the right to designate the corresponding attack as a fur coat, that is, a shift in the mental state of the patient. At the same time, even with a paroxysmal-progressive course, the development of an attack of oneiric catatonia may not affect the further course of the disease, which excludes the qualification of this condition as a fur coat. In some cases, disorders observed at the beginning of the disease, reminiscent of the picture of “simplex syndrome” or a sluggish course after one of the attacks, can be transformed into a state with interpretive or paranoid delusions. And, conversely, changes in the nature of the disorders that characterize the continuous course of the disease are not always accompanied by a change in the nature of the attacks. Thus, the clinical manifestations of paroxysmal-progressive schizophrenia are extremely diverse. Along with cases that undoubtedly come close to variants of continuous and recurrent schizophrenia, when there is a “tropism” of attacks of a certain psychopathological structure to various types continuous flow, there is big number observations where this relationship is absent. The question arises: which cases of paroxysmal-progressive schizophrenia are most characteristic of it - those close to continuous and recurrent schizophrenia or those in which certain patterns in the development of the disease are absent and the logical sequence in the occurrence of attacks is impossible to grasp. We can say with certainty that we are talking about a continuum, where at one pole there are cases that obey certain patterns in the development of the disease, and at the other there are cases in which such a pattern is absent; the space between them is occupied by clinical observations, gravitating towards different poles. Questions about the prognostic significance of attacks and features of the course of paroxysmal-progressive schizophrenia in general most clearly arise in cases of the course of the disease with so-called febrile attacks, or febrile schizophrenia (see section “Special forms of schizophrenia").

In the initial period, negative personality changes typical for schizophrenia appear and gradually progress, and in some cases productive symptoms in the form of obsessions, depersonalization, overvalued or paranoid ideas. Next, manifest and subsequent attacks occur in the form of transient, qualitatively new disorders in relation to the permanent symptoms.

In some patients with fur-like schizophrenia, negative personality changes and chronic productive disorders progress slowly and in the intervals between attacks.

The degree of progression of fur coat-like schizophrenia and the depth of the developing mental defect vary significantly. In some cases, fur coat-like schizophrenia is close to a malignant form and ultimately ends in a final state (schizophrenic dementia), in others, due to the low severity of progressive tendencies, it is close to sluggish schizophrenia and leads to a shallow personality defect. Most cases of fur coat schizophrenia fall somewhere between these extremes.

Special forms of schizophrenia. The essence of paranoid schizophrenia lies in the emergence and long-term existence of systematized delusions. In some patients, delirium develops acutely - like an insight, in others gradually - on the basis of previous highly valuable ideas. The clinical manifestations of paranoid schizophrenia have significant similarities with the paranoid stage of paranoid schizophrenia described above.

Febrile schizophrenia (fatal catatonia, hypertoxic schizophrenia) is called acute attacks of oneiric catatonia within the framework of recurrent and paroxysmal-progressive schizophrenia, accompanied by hyperthermia and other somatic disorders. Along with catatonia in the form of stupor or agitation, rises in body temperature up to 38–40 °C occur for up to 2 weeks. The temperature curve does not correspond to typical temperature fluctuations in somatic and infectious diseases. Dry mucous membranes, skin hyperemia, bruising, sometimes bullous rashes, and ulceration of the skin are noted.

Remission usually occurs after a few weeks. In rare cases, death can occur. Sometimes the patient suffers several attacks of febrile schizophrenia.

Treatment and rehabilitation. Almost all methods are used in the treatment of patients with schizophrenia biological therapy and most psychotherapy methods.

Biological therapy. The leading place in the biological treatment of schizophrenia belongs to psychopharmacotherapy. The main classes of psychotropic drugs used are antipsychotics and antidepressants. Drugs of other classes are used less frequently.

For paranoid schizophrenia, neuroleptic antipsychotics (haloperidol, triftazine, rispolept, azaleptin, fluanxol) are used. After improvement of the condition and partial reduction of hallucinatory-delusional disorders, long-term (usually many years) maintenance therapy is carried out, often with the same drugs, but in smaller doses. Injection depot forms of antipsychotics (haloperidol decanoate, moditen-depot, fluanxol-depot) are often used. In the first 2 years after the development of hallucinatory-paranoid disorders, insulin comatose therapy is possible (with the consent of the patient or his relatives). Paranoid syndrome and chronic verbal hallucinosis are particularly resistant to therapy.

Long-term use of antipsychotics often leads to patient intolerance to the drugs, mainly in the form of neurological side effects and complications (neurolepsy, tardive dyskinesia). In these cases, antipsychotics should be used that do not cause or almost do not cause side neurological effects (Leponex, Rispolept, Zyprexa).

In patients with psychomotor agitation, injectable neuroleptics with inhibitory properties (clopixol-acufaz, aminazine, tizercin, haloperidol, topral) are used in the structure of various attacks.

Treatment of febrile schizophrenia is carried out in intensive care units whenever possible. Active detoxification is used, including hemosorption, hemodez, as well as symptomatic therapy and sometimes chlorpromazine. In cases of particularly severe condition (according to vital indications), ECT is performed.

In interictal intervals, outpatient therapy is carried out to stabilize remission and prevent new attacks. Often the same drugs are used as during attacks, but in smaller doses. When the proportion of affective disorders in the structure of attacks is high, mood stabilizers (lithium carbonate, finlepsin, sodium valproate) are prescribed for a long time.

Drug treatment of sluggish schizophrenia is carried out with a combination of small or medium doses of antipsychotics or neuroleptics with a milder effect (Sonapax, neuleptil) and antidepressants.

Psychotherapy. Psychotherapy occupies an essential place in the treatment of patients with schizophrenia.

In the presence of severe psychotic symptoms (paranoid schizophrenia, psychotic attacks of recurrent and fur-like schizophrenia), patients need the participation, encouragement, and support of a doctor. Demonstration of a skeptical attitude towards delusional judgments and attempts to refute them are unproductive and only lead to disruption of contact between the doctor and the patient. Explanations of what statements and forms of behavior of the patient are assessed by others as painful are justified. Family psychotherapy is useful (psychotherapeutic work with the patient’s relatives, aimed at developing the correct attitude towards his painful statements and behavior, at eliminating intra-family conflicts that often arise as a result of painfully changed behavior of a family member).

For non-psychotic levels of disorders (remission of paroxysmal schizophrenia, sluggish schizophrenia), systematic psychotherapy, mainly rational (cognitive) and behavioral, is indicated.

Techniques of stimulating and distracting psychotherapy are used. Special techniques are used aimed at eliminating certain disorders, for example, functional training for transport phobias.

Methods such as hypnosuggestive psychotherapy, autogenic training, and psychoanalytic psychotherapy are used in patients with schizophrenia to a limited extent due to the risk of worsening the patient’s condition and low effectiveness.

Social rehabilitation is indicated for almost all patients with schizophrenia (the exception is patients with preserved ability to work and sufficient social adaptation).

In such cases, the process of social rehabilitation is multi-stage in nature. It often begins during the hospitalization period with the involvement of patients in performing simple household tasks.

In cases of sluggish schizophrenia, recurrent schizophrenia with rare attacks, properly organized social rehabilitation in combination with treatment often makes it possible to maintain or restore pre-morbid professional, family and social status.

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