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Psychological features of a patient with schizophrenia

The change in the interpretation of the environment, associated with a change in perception, is especially noticeable in the initial stages of schizophrenia and, judging by some studies, can be detected in almost two-thirds of all patients. These changes can be expressed both in an increase in perception (which is more common) and in its weakening. Changes associated with visual perception are more common. Colors appear brighter, color tones appear more saturated. There is also a transformation of familiar objects into something else. Changes in perception distort the outlines of objects, making them threatening. Color shades and the structure of the material can, as it were, pass into each other. The aggravation of perception is closely related to the overabundance of incoming signals. It's not that the senses become more receptive, but that the brain, which usually filters out most of the incoming signals, for some reason does not. So many external signals bombarding the brain make it difficult for the patient to concentrate and concentrate. According to some reports, more than half of patients with schizophrenia note a disorder of attention and a sense of time.

A significant group of symptoms in the diagnosis of early schizophrenia are disorders associated with difficulty or inability to interpret incoming signals from the outside world. Auditory, visual and kinesthetic contacts with the environment cease to be understandable for the patient, forcing him to adapt to the surrounding reality in a new way. This can be reflected both in his speech and in his actions. With such violations, the information coming to the patient ceases to be integral for him and very often appears in the form of fragmented, separated elements. For example, when watching television programs, the patient cannot watch and listen at the same time, and vision and hearing appear to him as two separate entities. The vision of ordinary objects and concepts - words, objects, semantic features of what is happening is disturbed.

The strongest impression on others and in general on the whole culture as a whole, which was expressed even in dozens of works on this topic, is produced by the delirium and hallucinations of a patient with schizophrenia. Delusions and hallucinations are the best known symptoms of mental illness and schizophrenia in particular. Of course, it should be remembered that delusions and hallucinations do not necessarily indicate schizophrenia and schizophrenic nosology. In some cases, these symptoms do not even reflect general psychotic nosology, being the result, for example, of acute poisoning, severe alcohol intoxication, and in some other morbid conditions. However, the appearance of hallucinations and delusions in a person "out of nowhere" can accurately indicate the onset (or active phase) of a mental illness. It is also necessary to distinguish between unsystematized and systematized nonsense. In the first case, we are talking, as a rule, about such an acute and intense course of the disease that the patient does not even have time to explain what is happening to himself. In the second, it should be remembered that delirium, having the nature of self-evident for the patient, can be disguised for years under some socially controversial theories and communications. Hallucinations are considered typical in schizophrenia, they complete the spectrum of symptoms, which are based on a change in perception. If illusions are erroneous perceptions of something that really exists, then hallucinations are an imaginary perception, a perception without an object. The hallucinating person hears voices that do not exist and sees people (objects, phenomena) that do not exist. At the same time, he has complete conviction in the reality of perception. In schizophrenia, auditory hallucinations are the most typical. They are so characteristic of this disease that, based on the fact of their presence, the patient can be given a primary diagnosis of "suspicion of schizophrenia", which may or may not be confirmed, remaining within a different nosological form. The appearance of hallucinations indicates a significant severity of mental disorders. Hallucinations, which are very frequent in psychoses, never occur in neurotic patients. Observing the dynamics of hallucinosis, one can more accurately establish its belonging to one or another nosological form. For example, in alcoholic hallucinosis, the “voices” speak of the patient in the third person, while in schizophrenic hallucinosis they often turn to him, comment on his actions or order him to do something. It is especially important to pay attention to the fact that the presence of hallucinations can be learned not only from the patient's stories, but also from his behavior. This may be necessary in cases where the patient hides hallucinations from others. Objective signs of hallucinations, which most often reveal the plot of the hallucination in sufficient detail, may indicate a progressive disease.

Closely associated with delusions and hallucinations is another group of symptoms characteristic of many patients with schizophrenia. If a healthy person clearly perceives his body, knows exactly where it begins and ends, and is well aware of his "I", then the typical symptomatology of schizophrenia is distortion and irrationality of ideas. These representations in a patient can vary in a very wide range - from minor somatopsychic disorders of self-perception to the complete inability to distinguish oneself from another person or from some other object of the outside world. Violation of the perception of oneself and one's "I" can lead to the fact that the patient will no longer distinguish himself from another person. He may begin to believe that, in fact, he is of the opposite sex. And what is happening in the outside world can rhyme with the patient with his bodily functions (rain is his urine, etc.).

Changes in emotions are one of the most typical and characteristic changes in schizophrenia. In the early stages of this disease, emotional changes such as depression, guilt, fear, and frequent mood swings can manifest. In the later stages, a decrease in the emotional background is characteristic, in which it seems that the patient is not at all able to experience any emotions. In the early stages of schizophrenia, depression is a common symptom. The picture of depression can be very distinct, prolonged and observable, or it can be disguised, implicit, the signs of which are visible only to the eye of a specialist. According to some reports, up to 80% of patients with schizophrenia exhibit some episodes of depression, and in half of the patients, depression precedes the onset of delusions and hallucinations. In such cases, early diagnosis of schizophrenia is very important, since after the crystallization of delusional states and judgments, the disease passes into a different form, which is more difficult to treat. The patient has a lot of unmotivated emotional experiences: guilt, causeless fear, anxiety.

A change in the general mental picture of the world in a patient inevitably leads to a change in his motor activity. Even if the patient carefully hides the pathological symptoms (the presence of hallucinations, visions, delusional experiences, etc.), it is possible, nevertheless, to detect the appearance of the disease by its changes in movements, when walking, when manipulating objects and in many other cases. The movement of the patient can accelerate or slow down for no apparent reason or more or less intelligible ways to explain this. Feelings of clumsiness and confusion in movements are widespread (often unobservable and, therefore, valuable when the patient himself shares such experiences). The patient may drop things, or constantly bump into objects. Sometimes there are short "freezes" during walking or other activity. Spontaneous movements (hand wave when walking, gesticulation) may increase, but more often they acquire a somewhat unnatural character, are restrained, as it seems to the patient that he is very clumsy, and he tries to minimize these manifestations of his awkwardness and clumsiness. Repetitive movements are observed: tremors, sucking movements of the tongue or lips, tics, and ritual motor patterns. An extreme version of movement disorders is the catatonic state of a patient with schizophrenia, when the patient can maintain the same position for hours or even days, being completely immobilized. The catatonic form occurs, as a rule, in those stages of the disease when it was started, and the patient did not receive any treatment for one reason or another.

Changes in the patient's behavior are usually secondary symptoms of schizophrenia. That is, changes in the behavior of patients with schizophrenia are usually a reaction to other changes associated with a change in perception, impaired ability to interpret incoming information, hallucinations and delusions, and other symptoms described above. The appearance of such symptoms forces the patient to change the usual schemes and methods of communication, activity, and rest. It should be borne in mind that the patient, as a rule, has absolute confidence in the correctness of his behavior. Absolutely ridiculous, from the point of view of a healthy person, the actions of a patient with schizophrenia have a logical explanation and conviction that they are right. The patient's behavior is not a consequence of his wrong thinking, but a consequence of a mental illness, which today is quite effectively treatable with psychopharmacological drugs and appropriate clinical care.

Treatment of schizophrenia

Medications are the primary treatment for schizophrenia. These include such well-known drugs as Halopyridol, Orap, Semap, Triftazin, Tizercin, and others. These drugs help correct strange behavior in patients, but they can also cause side effects such as drowsiness, hand tremors, muscle stiffness, or dizziness. To eliminate these side effects, it is necessary to use the drugs Cyclodol, Akineton. Drugs such as Clozapine, for example, cause fewer side effects, but regular blood tests should be done while taking Clozapine. Recently, new generation drugs have appeared, such as Rispolept, which have a minimum number of side effects, which can significantly improve the quality of life of patients.

Supportive psychotherapy and counseling are often used to help a person with schizophrenia. Psychotherapy helps people with schizophrenia feel better about themselves, especially those who experience irritation and feelings of worthlessness as a result of schizophrenia, and those who seek to deny the presence of this disease. Psychotherapy can equip the patient with ways to deal with everyday problems.

Social rehabilitation is a set of programs aimed at teaching people with schizophrenia how to maintain independence, both in the hospital and at home. Rehabilitation focuses on teaching social skills for interacting with other people, skills needed in everyday life such as managing one's own finances, cleaning the house, shopping, using public transport, etc., vocational training, which includes activities necessary to obtain and job retention, and continuing education for those patients who want to graduate from high school, go to college, or graduate from college. Some patients with schizophrenia successfully receive higher education.

A day treatment program consists of some form of rehabilitation, usually as part of a program that also includes drug therapy and counseling. Group therapy is aimed at solving personal problems, and also enables patients to help each other. In addition, social, recreational and labor events are held within the framework of daily programs. The day treatment program may be hosted in a hospital or mental health center, and some programs provide accommodation for patients discharged from the hospital.

Psychosocial rehabilitation centers, in addition to participating in many activities of the day treatment program, offer mentally ill people to become members of a social club. It should be remembered, however, that such programs do not provide medication or counseling and that they are not usually associated with a hospital or local mental health center. Their main purpose is to provide patients with a place where they can feel at home, and in work skills training that prepares members of the social club to perform certain professional duties. Such programs often provide for patients to live in "collective" houses and apartments.

Conclusion

Most people with schizophrenia are not violent and do not pose a danger to other people. Some patients, however, feel worthless and think that other people treat them badly because they have schizophrenia. It is important that people with schizophrenia understand that they are no worse than other people, and follow the generally accepted rules of everyday communication with other people.

Patients with schizophrenia should do everything possible to recover. Often these are intelligent and talented people, and even despite strange thoughts, they should try to do what they have learned before, and also try to acquire new skills. The participation of such patients in treatment and rehabilitation programs, as well as the implementation of their professional activities or the continuation of education, to the extent possible, is important.

People with schizophrenia find it difficult to tolerate being yelled at, irritated, or told to do something they cannot do. Family members can help the patient avoid stress by following the rules listed below:

Do not yell at the patient and do not say anything to him that can piss him off. Instead, praise the patient more for good deeds.

Do not argue with the patient and do not try to deny the existence of strange things that he hears or sees.

Keep in mind that ordinary events - moving to a new place of residence, getting married, or even a festive dinner - can irritate schizophrenic patients.

Do not get involved in the problems of a sick relative

Show love and respect for the patient. Remember that people with schizophrenia often get into trouble and sometimes feel bad about themselves because of the illness.

In the process of treatment, the symptoms of the disease can either appear or disappear. Family members should know what to expect from the patient in terms of household chores, work, or social interactions.

Studies have shown that the majority of patients whose symptoms of schizophrenia were so severe that they had to be hospitalized improved. The condition of many patients may become better than at present, and almost one third of patients may recover and no longer have any symptoms. In groups led by former patients, there are people who once had very severe schizophrenia. Now many of them work, some are married and have their own home. A small proportion of these people have resumed their college education, and some have already completed their education and got into good professions. New scientific research is constantly being carried out, and this gives reason to hope that cures for schizophrenia will be found. Our time is a time of hope for those with schizophrenia.

Bibliography

1. Garrabe J. History of schizophrenia. M., St. Petersburg: B.I., 2000.

2. Psychiatry, Zharikov N.M., Ursova L.G., Khritinin D.F., / M., Medicine, 1989.

3. Guide to psychiatry, G.V. Morozov, M.: Medicine, 1988.

4. Schizophrenia. Clinic and pathogenesis A. V. Snezhnevsky. M.: Medicine, 1969.

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When analyzing changes in personality and mental processes, according to the conversation, observation and pathopsychological research, the following characteristic varieties of symptoms are distinguished: thinking disorders, speech disorders, emotional disorders, personality disorders, motor disorders. Let's consider them in more detail.

Thinking disorders include:
delusions of specific content. Typical delusions expressed by patients with schizophrenia are ideas of persecution; control exercised over them by certain external forces; the connection of all the events taking place around with the life of the patient; sin or violence; illness; nihilistic ideas; ideas of grandiosity, of one's own greatness.

K. Jaspers gives examples of eschatological (associated with the end of the world) and at the same time grandiose self-descriptions of the life world of patients with schizophrenia:

“In connection with my ideas about the end of the world, I had countless visions. ... In one vision, I was descending on an elevator into the depths of the Earth, and on this way I seemed to have gone backwards through the entire history of mankind. Leaving the elevator, I found myself in a huge cemetery”; “If you don’t find a replacement for me, everything will be lost”, “All the clocks in the world feel my pulse”, “My eyes and the sun are one and the same” (Jaspers, K General Psychopathology, p. 361).

At the same time, schizophrenic worlds are not built according to one model. Rather, a healthy person will understand a patient with schizophrenia than one patient - another. This is evidenced by a typical example from the practice of the famous psychiatrist M. Rokeach. In the clinic where he worked, in 1959 there were three patients with schizophrenia at the same time, each of whom declared that he was Jesus Christ. The following quote is a verbatim transcript of their first meeting with each other:

"Well, I know something about your psychology," said Clyde, "... and your North Bradley Catholic Church, and your education, and all that crap. I know exactly what these guys are doing. .. It testifies in my favor that I only do real things.
“Where I left off when I was interrupted,” Leon said, “is what happened when man was made in the image and likeness of God, before the beginning of time.”
"And he's just a divine creation, that's all," Joseph said. - "Man was created by me after I created the world - and nothing more."
"Did you create Clyde as well?" Rokeach asked.
“W-well, him and more,” laughed Clyde (quoted in Bootzin, R. Abnormal psychology, p. 351).

Rokeach was expecting a heated argument over who the real Messiah was, but the above recording shows a lack of even normal dialogue.

Rokeach placed these patients in adjacent beds and gave them instructions forcing them to stay in the same room. He then observed the patients for two years to see how their delusions changed from being next to each other. However, even after this time, each of the sick was convinced that he was the Christ;

• subjective sensation of thought translation (it seems to the patient that his thoughts are being transmitted to other people), putting other people's thoughts into the head, taking thoughts away;
• distortion of the generalization process, diversity and reasoning, as well as violations of criticality in thinking. These violations are most clearly manifested in tasks with a “blank instruction”, with an undefined clearly defined way to complete the task, as evidenced by the example below.

Example 2.29. Cohen experiment
Cohen and co-authors proposed the following task to a group of healthy people and a group of patients with schizophrenia. They were presented with two colored disks. It was necessary to describe the disks in such a way that the partner of the subject could identify them by verbal description and present them to the experimenter. When the discs were very different in color, there were no problems. When the discs differed slightly - in shade, patients with schizophrenia began to use strange signs to describe them, for example, “Makeup. Put it on your face and all the guys will run after you." For comparison, here is a description of a healthy person: "One more red"<цвет>. (Quoted in Bootzin, R. Abnormal psychology, p. 355).

Associations of patients are peculiar and chaotic. According to Yu.F. Polyakova, V.P. Kritskaya et al.1, in the process of solving intellectual problems, patients with schizophrenia are characterized by an increase in the number of non-essential and a decrease in the number of practically significant properties of objects used to find the answer. The subjects offer, for example, the following answers: “a clock and a river are similar in that they shine and have a transparent surface, are cyclical, they have stones”; “a shoe and a pencil are similar in that they are pointed and stored in a box,” etc. Moreover, in the course of the study, patients with schizophrenia did not reveal a more pronounced ability in comparison with healthy people to isolate the latent properties of objects, if the conditions of the task were strictly defined. Rather, according to the authors, in patients with schizophrenia, the determination of cognitive activity by social factors is weakened, and this leads to a violation of selectivity in thinking.

Violation of the purposefulness of thinking leads to the loss of its productivity, which is in sharp contrast to the presence of the patient's intellectual abilities necessary to complete the task. For example, such a patient classifies objects according to disparate features or offers several options, none of which he can stop at.

Schizophrenic reasoning has a peculiar character. It is distinguished by low emotionality, a tendency to slip on side topics, pretentious judgments, an inadequate choice of the subject of conversation, verbosity and inappropriate pathos.

If we generalize the approach of Russian pathopsychology to the explanation of schizophrenic changes in thinking, then the scheme of their occurrence can be represented as follows:
The mechanism of formation of thought disorders in schizophrenia:

Autism > Weakening of social orientation > Defect of thinking.

Distortion of the generalization process, diversity and reasoning are observed especially clearly in the picture of schizophrenic syndromes with a predominance of negative psychopathological manifestations, and outside of acute psychotic attacks.

Speech disorders. The speech of patients with schizophrenia is characterized by a peculiar vocabulary, a tendency to use neologisms, a low use of expressive means (facial expressions, intonation), and in some cases, incoherence. There is often a tendency to rhyme statements. Yu.F. Polyakov and his collaborators investigated the process of actualization of speech connections based on past experience in patients with schizophrenia. The tasks were as follows:

• the subject was called the first syllable of the word, he had to complete the word in order to get a noun, a common noun;
• the subject was presented by ear with phrases with an unclear ending (The man lit a cigarette ..., he will return in ten ...), which also had to be completed.

It was found that patients with schizophrenia, compared with healthy people, are characterized, firstly, by less standard answers, and secondly, by the tendency, when choosing words, to focus on the sound, and not on the meaning of an incomplete sentence.

Emotion disorders. Emotional coldness is one of the most visible manifestations of schizophrenia. Patients look detached, indifferent, weakly react even to strong emotional stimuli. At the same time, in connection with delirium, they may experience strong emotions, the content of which is inadequate to the situation. Patients with schizophrenia may also be characterized by ambivalence of emotions, i.e. the presence in consciousness simultaneously of two different types of emotional attitude.

Personality disorders. In schizophrenia, autism, loss of motive power, violation of criticality to one's state and behavior, self-awareness disorders, and the formation of pathological motives are observed.

Autism can be defined as a lack of social orientation, a decrease in the ability to regulate activity by social motives, due to a decrease in the need for communication. The social orientation of a person is expressed primarily in the readiness to communicate with others, in the search for contacts, in the orientation towards external evaluation. Communication disorders are also detected in the pathopsychological examination of patients with schizophrenia. Thus, when classifying images of human faces and situations of interpersonal interaction, a decrease in orientation towards socially significant features, a decrease in the differentiation of perception of social situations are revealed. In one of the experiments, patients were asked to give 12 personal characteristics of people that distinguish between those they like and those they don't like. Some patients could not give more than two characteristics.

Very characteristic of schizophrenia are changes in the motivational-need sphere. B.V. Zeigarnik, relying on the theory of activity, singles out the motivating and meaning-forming function of motives, the merging of which makes it possible to consciously regulate activity. Schizophrenia is characterized by the transformation of motives into “only known ones”, which leads to a significant disruption in the productivity of activity, its impoverishment, and the inability to regulate it in accordance with the changed situation. The circle of semantic formations gradually narrows, what previously worried the patient loses all meaning for him. In psychiatric classifications, this disorder is described as one of the varieties of abulia, i.e. partial or complete absence of desires or urges. Let's take an example from our own practice.

Example 2.30. Dysregulation of activity in a patient with schizophrenia
The patient turns to the psychologist by phone with a request to tell how to issue a certificate for referral to a sanatorium. Having received a detailed answer, he thanks and informs that he has been suffering from a stomach ulcer for a long time, that he needs to finally take care of his health, etc. A month later, she calls again - to discuss the upcoming trip, to consult on the choice of a particular sanatorium. From the conversation it turns out that the patient not only did not issue a certificate, but even never left the apartment in the past time.

As Russian researchers note, the motivational sphere of the patient is immobile, new events in life do not acquire personal meaning. At the same time, in the presence of delusions and overvalued ideas in patients with schizophrenia, one can observe the formation of pathological motives, which are distinguished by significant strength and stability.

Motor disorders in schizophrenia, they primarily include manifestations of catatonia. In a state of stupor, patients are inactive, do not enter into verbal contact, do not respond to stimuli, do not obey the requests of others, freeze in the same position and resist attempts to change it. At the same time, they can go into a state of violent motor excitement, move quickly, talk incoherently or scream, in some cases, they try to harm themselves or attack others.

With an unfavorable course, schizophrenia leads to the emergence of a psychological defect with a predominance of negative symptoms: autism, emotional insufficiency, decreased mental activity, dissociation of mental activity (strangeness and unusual behavior, reduced criticality with a relative preservation of formal intelligence).

There are two main types of schizophrenic defect - partial and total. A partial defect is characterized by schizoid changes in the psyche, primarily in the emotional sphere, in the form of coldness, disruption of life contacts, combined with increased vulnerability and sensitivity to oneself. Patients are characterized by practical unsuitability, inconsistency in work and study. At the same time, they have vast reserves of knowledge, one-sided hobbies. The level of regulation of behavior in the case of a partial defect remains high in those types of activity in which the role of the social factor is small.

Total schizophrenic defect is characterized by the presence of pseudo-organic changes. Patients have a deficit of activity and emotional expressiveness, poverty of motives and interests, limited knowledge, passivity and lethargy, autism and mental immaturity. All this leads to a significant decrease in the productivity of mental activity. Despite the difference between these two varieties of the defect, that in both cases the patient has thought disorders specific to schizophrenia, for example, loss of selectivity, peculiarity of associations, etc. This is not schizophrenic dementia, but schizophrenic dissent.

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The concept of schizophrenia. General clinical characteristics

Etiology

Pathogenesis

pathological anatomy

Diagnosis of schizophrenia

Clinical forms of schizophrenia

Ongoing schizophrenia

Periodic schizophrenia

Fur coat schizophrenia

Treatment of schizophrenia

Prevention of schizophrenia

Caring for a person with schizophrenia

Literature

The concept of schizophrenia. General clinical characteristics

Schizophrenia is a progressive mental illness of unknown etiology, prone to a chronic course, occurring with polymorphic symptoms and leading to a special personality defect, different from the defect that occurs with grossly organic brain lesions. It is manifested by typical changes in the patient's personality and other mental disorders of varying severity, often leading to persistent disorders of social adaptation and disability.

With this disease, patients become withdrawn, lose social contacts, they have a depletion of emotional reactions. At the same time, various degrees of severity of disorders of sensations, perception, thinking and motor-volitional disorders are observed.

It is also noted: a decrease in energy potential (will), progressive introversion (phenomena of autism), emotional impoverishment, against which there can be a variety of psychopathic disorders (delusions, allucinations, senestopathies). Memory and acquired knowledge are preserved.

Schizophrenia as a separate disease was first identified by the German psychiatrist E. Kraepelin. He took groups of patients who had previously been described with diagnoses of hebephrenia, catatonia, and paranoids, and, following them catamnestically, established that in the long-term period they had a kind of dementia. In this regard, he combined these three groups of painful conditions and called them early dementia (dementia praecox).

Subsequently, the Swiss psychiatrist E. Bleiler proposed a new name for this disease: "schizophrenia" (from the Greek schizo - splitting, phren - soul). He believed that this disease is most characteristic not of an outcome in a kind of dementia, but a special dissociation of the mental processes of the personality, its specific change as a result of a painful process. They were identified primary and secondary signs of the disease. Bleuler attributed the loss of social contacts (autism), impoverishment of emotionality, splitting of the psyche (special disorders of thinking, dissociation between various mental manifestations, etc.) to the primary ones. All these mental disorders were qualified as a personality change of the schizophrenic type. These changes were of decisive importance in the diagnosis of schizophrenia.

Other mental disorders, defined by Beyler as secondary, additional, are manifested by senestopathy, illusions and hallucinations, delusions, catatonic disorders, etc. He did not consider these disorders to be mandatory for schizophrenia, since they also occur in other diseases, although some of them may be more characteristic of schizophrenia.

The psychopathological manifestations of schizophrenia are very diverse. According to their characteristics, they are divided into negative and productive. The negative ones reflect the perversion of functions, the productive ones represent the identification of special psychopathological symptoms: hallucinations, delusions, affective tension, etc. Their state and representation in the mental state of the patient depend on the progression and form of the disease.

For schizophrenia, as noted, the most significant are peculiar disorders that characterize changes in the patient's personality. The severity of these changes reflects the malignancy of the disease process. These changes concern all mental properties of the personality. However, the most typical are intellectual and emotional.

Intellectual disorders manifest themselves in various ways of thinking disorders: patients complain of an uncontrollable stream of thoughts, their blockage, and parallelism. Schizophrenia is also characterized by symbolic thinking, when the patient explains individual objects, phenomena in his own way, only for him a meaningful meaning. For example, he regards a cherry bone as his loneliness, and an outstanding cigarette butt as a burning life. In connection with the violation of internal inhibition, the patient experiences gluing (agglutination) of concepts.

He loses the ability to distinguish one concept from another. In words, sentences, the patient catches a special meaning, new words appear in speech - neologisms. Thinking is often vague, in statements there is, as it were, slipping from one topic to another without a visible logical connection. Logical inconsistency in statements in a number of patients with far-reaching painful changes takes on the character of speech fragmentation of thinking in the form of "verbal okroshka" (schizophasia). This occurs as a result of the loss of unity of mental activity.

Emotional disorders begin with the loss of moral and ethical properties, feelings of affection and compassion for loved ones, and sometimes this is accompanied by hostility and malice. Decreases, and over time, and completely disappears interest in your favorite business. Patients become untidy, do not observe elementary hygienic personal care. An essential feature of the disease are also the characteristics of the behavior of patients. An early sign of it may be the appearance of autism: isolation, alienation from loved ones, strangeness in behavior (unusual actions, behavior that were previously not characteristic of the individual and whose motives cannot be associated with any circumstances). The patient withdraws into himself, into the world of his own painful experiences. The thinking of the patient in this case is based on a perverted reflection in the consciousness of the surrounding reality.

During a conversation with a patient with schizophrenia, when analyzing their letters, essays, in some cases it is possible to reveal in them a tendency to resonant reasoning. Reasoning is empty sophistication, for example, the incorporeal reasoning of the patient about the design of the cabinet table, about the expediency of four legs for chairs, etc. This is quite common in the clinic of schizophrenia.

Emotional-volitional impoverishment develops after a certain time after the start of the process and is clearly expressed with exacerbation of painful symptoms. Initially, the disease may be in the nature of dissociation of the patient's sensory sphere. He can laugh at sad events and cry at joyful ones. This state is replaced by emotional dullness, affective indifference to everything around and especially emotional coldness to relatives and relatives.

Emotional-volitional impoverishment is accompanied by lack of will - abulia. Patients do not care about anything, they are not interested, they have no real plans for the future, or they speak about them extremely reluctantly, in monosyllables, not revealing the desire to implement them. The events of the surrounding reality almost do not attract their attention. They lie in bed for days on end, not interested in anything, doing nothing.

Emotional and volitional disorders are usually interrelated in the clinical picture of schizophrenia and accompany each other. In schizophrenia, two similar symptoms are quite common - ambivalence and ambivalence, as well as negativism.

Ambivalence is the duality of ideas, feelings, existing simultaneously and oppositely directed. Ambition is a similar disorder, manifested in the duality of the patient's aspirations, motives, actions, tendencies. For example, a patient declares that he loves and hates at the same time, considers himself sick and healthy, that he is a god and a devil, a tsar and a revolutionary, and so on. Negativism is the desire of the patient to perform actions opposite to those proposed. Negativism is based on the mechanisms of paradoxical inhibition in various spheres of mental activity.

Also typical for schizophrenia are various peculiar senestopathic manifestations: unpleasant sensations in the head and other parts of the body. Senestopathies are pretentious in nature: patients complain of a feeling of fullness of one hemisphere in the head, dryness of the stomach, etc. The localization of senestopathic manifestations does not correspond to the painful sensations that may be with somatic diseases.

Perceptual disorders are manifested mainly by auditory hallucinations and often by pseudo-hallucinations of various sense organs: visual, auditory, olfactory, etc. From delusional experiences, it is also possible to observe various forms of delusion: paranoid, paraphrenic; in the early stages, more often paranoid. Characteristic of schizophrenia is the delirium of physical impact, which is usually combined with pseudo-hallucinations and is called the Kandinsky-Clerambault syndrome.

Motor-volitional disorders are diverse in their manifestations. They are found in the form of a disorder of voluntary activity and in the form of a pathology of more complex volitional acts. One of the brightest types of violation of voluntary activity is the catatonic syndrome. It includes states of catatonic stupor and arousal. By itself, catatonic stupor can be of two types: lucid and oneiroid.

With lucid stupor, the patient retains an elementary orientation in the environment and its assessment, while with oneiroid stupor, the patient's consciousness is changed. Patients with lucid stupor, after leaving this state, remember and talk about the events that took place around them at that time. Patients with oneiroid states report fantastic visions and experiences, in the power of which they were in the period of a stuporous state. Catatonic excitation is meaningless, non-purposeful, sometimes taking on the character of a motor. The movements of the patient are monotonous (stereotyping) and, in fact, are subcortical hyperkinesis; aggressiveness, impulsive actions, negativism are possible; facial expression often does not match the posture (mimic asymmetries may be observed). In severe cases, there is no speech, mute excitement or the patient growls, grunts, shouts out individual words, syllables, pronounces vowels. Some patients show an irrepressible urge to speak. At the same time, speech is pretentious, stilted, repetitions of the same words (perseveration), fragmentation, senseless stringing of one word on another (verbigeration) are noted. Transitions from catatonic excitation to a stuporous state and vice versa are possible.

Catatonia, in general, is divided into lucid and oneiroid. Lucid catatonia proceeds without clouding of consciousness and is expressed by stupor with negativism or numbness or impulsive arousal. Oneiroid catatonia includes oneiroid clouding of consciousness, catatonic agitation with confusion, or stupor with waxy flexibility.

Hebephrenic syndrome is close to catatonic both in origin and manifestations. It is characterized by excitement with mannerisms, pretentiousness of movements and speech, foolishness. Fun, antics and jokes do not infect others. Patients tease, grimace, distort words and phrases, tumble, dance, expose themselves. There are transitions between catatonia and hebephrenia.

More complex volitional acts, volitional processes are also subject to various disturbances under the influence of the disease. The most typical is the increase in the decrease in volitional activity, which ends with apathy and lethargy. However, in some patients there may be an increase in activity associated with certain morbidly conditioned ideas and attitudes. So, for example, in connection with delusional ideas and attitudes, patients are able to overcome exceptional difficulties, show initiative and perseverance, and do a lot of work. The content of painful experiences of delusional ideas in patients may be different. At the same time, it reflects the spirit of the time, certain socially significant phenomena. Over time, there is a modification of the content of the psychopathological manifestations of the disease. If in the past, the statements of patients often featured evil spirits, religious motives, witchcraft, now new achievements in science and technology.

Schizophrenia can begin at any age, but the most typical age period is 16-30 years, therefore it is of great social importance. At the same time, there are optimal terms for individual initial clinical manifestations of schizophrenia. So, schizophrenia with a paranoid manifestation begins more often at the age of over 30 years, with neurosis-like symptoms, thought disorders - in adolescence and youth. In men, the disease begins earlier than in women. In women, the disease is more acute, more often and pronounced, various affective pathologies are presented.

The progression of the course of schizophrenia is characterized by a gradual complication of the symptoms of the disease. Decrease in intelligence, weak-mindedness gradually accrue. Various psychopathological syndromes appear, the clinical characteristics of which depend on the form and stage of the process.

Etiology

The etiology of schizophrenia has not been precisely established. Distinguish between endogenous and exogenous factors that affect the occurrence of the disease. Inheritance is endogenous. The incidence of schizophrenia is higher among family members of patients. The risk increases with increasing degree of consanguinity. Among cousins, the incidence is 2.6%; among relatives 11-14%. Twin pairs also have their own characteristics: if one of the identical twins is sick, then the second will get sick in 77.6-91.5%; in heterozygous, the probability is 15-16%. The main patterns of the transmission of predisposition to schizophrenia, as well as the biological processes that underlie this predisposition, remain unclear. At the same time, only hereditary factors cannot determine all the complex patterns of the course of schizophrenia, and as the disease develops, the pathological mechanisms of the disease can change and become more complicated, thereby determining the kinetics of the pathological process in schizophrenia. Among the exogenous factors, there are: infections, mental trauma, intoxication, social and domestic factors, etc. In those cases when the disease develops over time following certain exogenous influences, the clinic of schizophrenia at the first stages of its course includes elements of "exogenous type" disorders, in the future these changes weaken, and the disease continues to develop according to its internal patterns. There is a direct relationship between the standard of living, material well-being and the incidence of morbidity: the lower the material level, the higher the incidence among these segments of the population.

Pathogenesis

Schizophrenia is a polygenic disease. The pathogenesis of schizophrenia is based on autointoxication of the patient's body with toxic metabolic products that can cause disruption of the normal activity of the central nervous system. Cell membranes are damaged. This damaging effect causes the formation of brain autoantigens and autoantibodies, the number of which depends on the degree and malignancy of the disease. Attempts to isolate these compounds from the body of patients with schizophrenia have not been successful. This theory has many variants, its essence is determined by the violation of one or another link of metabolism in a sick organism. Aromatic amino acids, adrenochrome, adrenolutin and serotonin cause schiophrenic toxicosis. Violation of protein metabolism (delay or increased excretion of nitrogenous wastes from the body) coincides with the characteristics of the clinical manifestations of the disease. However, this applies only to schizophrenia, which occurs intermittently with a predominance of catatonic disorders in the clinic. It is assumed that such disorders occur on constitutionally prepared soil (congenital inferiority of the endocrine apparatus, a decrease in the antitoxic function of the liver, a hereditary weakness of the nerve cells of the central nervous system), the author of this assumption is the scientist V.P. Protopopov. Another scientist, I.P. Pavlov, studying the pathogenesis of schizophrenia at various levels of processes of nervous activity, suggested that changes in the normal interaction of nervous processes occurring in the cortex and subcortical region disrupt the process of irradiation and concentration of inhibition, cause hypnoid states, etc. is a pathogenetic mechanism in the development of schizophrenia.

Clinical method for studying the pathogenesis of schizophrenia. If we consider the clinical manifestations of the disease as a reflection of certain pathophysiological mechanisms of brain activity, then by studying the external signs of the disease, one can learn the general patterns of development of the pathological process of schizophrenia, naturally not in a state of development of the disease, but clinical studies are the starting point when searching for the biological essence of the disease on any level of organization of physiological systems.

Pathological anatomy.

There is a complex of macro- and micro-changes characteristic of schizophrenia in the brain and some internal organs, in combination with clinical data that are important in assessing the pathological process as a whole and contributing to the delimitation of this disease from other psychoses.

Macroscopically, agonal areas of edema and anemia of the brain, small atrophic areas of retraction in the cortex, moderate fibrosis of the pia mater, and individual signs of anomalies in the development of the brain are revealed.

Microscopy. The pathological process involves the cerebral cortex, subcortical formations, the hypothalamus, the brainstem, and the cerebellum. The greatest changes are observed in the cortex and subcortex. Atrophic changes in nerve cells, lipoid sclerosis, excessive accumulation of lipofuscin in the cytoplasm of cells, hydroscopic dystrophy, direct and retrograde degeneration, atrophy of the lateral dendritic appendages, areas of demyelination of tangential and radial fibers, sometimes varying degrees of swelling, swelling. Decrease in the number of microgliocytes, their hypoplasia.

Typical defective reaction of microglia in response to exogenous hazards or complicating the main process of brain damage. These features of microglia are associated with insufficiency of protective reactions of the reticuloendothelial system of a patient with schizophrenia.

In general, the pathomorphology of the brain fits into the picture of toxic-hypoxic encephalopathy. In acute fatal cases, pronounced dyscirculatory disorders in the brain and internal organs predominate. In the internal organs, status lymphaticus is found, sometimes a significant density of parenchymal organs due to the growth of the stroma. Often they find hypoplasia of the cardiovascular system (reduction in the size of the heart, narrowness of the aorta).

Diagnostics.

Schizophrenia is distinguished by a wide range of clinical manifestations and a certain set of syndromes. The main diagnostic criteria are negative disorders typical of schizophrenia or peculiar changes in the patient's personality (impoverishment of emotional manifestations, impaired thinking and interpersonal relationships).

Differential diagnosis:

1. exogenous psychoses. They begin in connection with certain hazards (toxic, infectious, etc.). There are special personality changes according to the organic type. Psychopathological manifestations occur with a predominance of hallucinatory and visual disorders.

2. affective psychosis (manic-depressive psychosis). At the same time, psychopathological manifestations in the form of affective disorders. In the dynamics of the disease, there is no complication of syndromes.

3. neuroses. There are certain psychogenic hazards that cause their occurrence. Dynamics are different from neurosis-like schizophrenia.

4. psychopathy. Psychopathological symptoms are associated with interpersonal relationships, and psychopathic symptoms are determined by a progredient process.

Clinical forms of schizophrenia

A wide variety of clinical manifestations of the disease makes it necessary to identify individual forms that differ in symptoms and course.

1. according to the predominant syndrome:

Catatonic

hebephrenic

paranoid

Simple

hypochondriacal

Circular

neurosis-like

psychopathic

2. according to the nature of the predominant symptoms, the type of course, the degree of progression of the disease: - continuously ongoing

periodic

Paroxysmal-progredient (fur-like)

This classification covers the entire syndromology and allows you to trace the development of the disease in dynamics.

Ongoing schizophrenia

Depending on the degree of progression, malignant (nuclear), moderately progressive (paranoid) and indolent schizophrenia are distinguished.

Malignant schizophrenia. Begins in childhood and adolescence. Characterized by the onset of the disease with negative symptoms, usually preceding the appearance of productive symptoms, the rapidity of the course of the disease towards the outcome from the moment of manifestation, the polymorphism of productive symptoms in the absence of its systematization and syndromic completeness, an increase in resistance to therapy, and the severity of final conditions.

The initial period (initial) is characterized by a change in the entire mental structure of the personality. Mental development stops. Former interests, youthful liveliness and curiosity are lost. The impoverishment of the emotional sphere, the desire for communication, the former sympathy disappears. Family relationships are changing rapidly. Sluggish, passive, inactive outside the home, patients become callous, rude, hostile towards loved ones. The first sign is a rapidly increasing decline in mental productivity. New things are hard to come by. Progress is progressively falling, despite classes. The emergence of new interests that begin to dominate in the activities of patients is metaphysical intoxication. They are monotonous, pretentious, divorced from reality, one-sided.

The activities associated with them are unproductive and do not enrich the individual. New knowledge is not acquired, except for some randomly captured details. Fascination with philosophical problems (philosophical intoxication). Against the background of the above, there is an interest in philosophical literature that is inaccessible to the understanding of patients. They read, make long meaningless statements, talk about having a special worldview as a consequence of studying philosophy. Attempts to find out the essence of these views reveal complete helplessness, lack of elementary information, logic of judgments, which does not bother patients. The arguments are torn, resonant in nature. In other patients, one-sided activity comes to the fore: ridiculous collecting, persistent visits to the theater or stadium, construction. Unproductiveness, autistic nature, combined with general personality changes and a drop in mental productivity, are characteristic of this period of the disease, regardless of its specific content and the degree of activity of the patient. Neurosis-like disorders (obsessive, hypochondriacal, depersonalization) in a malignant course are absent or rudimentary. More often there are violations of the psychopathic circle. A number of symptoms of the initial period reveals some similarity with the signs of a pathological pubertal crisis. The manifest stage of malignant juvenile schizophrenia is usually preceded by the appearance of fragmentary crazy ideas: persecution, poisoning, sexual influence. The psychotic debut is acute with a polymorphic, changeable picture, in which the main sequence of symptom development can be distinguished: at first delusional, even hallucinatory and, last of all, catatonic manifestations predominate. These stages are compressed in time, their content is not systematized. With the rapid course of the disease, individual syndromes overlap each other. With the predominance of delusional disorders in the manifest stage, the course of the disease is slower.

The most malignant course is with early onset and subsequent dominance of hebephrenic and catatonic phenomena. The considered form of schizophrenia includes the previously described simple form, paranoid, hebephrenic and malignant catatonia.

The development of the hebephrenic variant begins with a drop in the energy potential or the appearance of emotional deficiency. In the future, against the background of the described changes, an acute psychotic state occurs with delusional hallucinatory experiences, behavioral disorders, characterized by polymorphism and unfolded symptoms. It then passes into a final state with rudimentary catatonic, delusional, and hallucinatory phenomena. Catatonic symptoms are manifested most often in foolish behavior.

The paranoid variant begins with the same negative phenomena, but before the development of the final state, neurosis-like (in the form of obsessions), paranoid (interpretive delirium without systematization and generalization) or psychopathic (in the form of excitability, rudeness, deceit, quarrelsomeness, a tendency to alcoholism or drug addiction) symptoms . Then these patients develop paranoid Kandinsky-Clerambault syndrome with unstable catatonic symptoms. As a result, the final state develops, characterized by speech discontinuity with elements of catatonia. With the catatonic variant, the beginning is the same. The acute psychotic state is exhausted by lucid catatonia at the level of stupor and substupor. Individual delusional and hallucinatory manifestations may be observed. The end state is characterized by rudimentary catatonic symptoms, predominantly at the level of the substupor.

Progredient (paranoid) schizophrenia. Begins at the age of 25 years. Manifestation in this form of schizophrenia is rare. The initial period is characterized by individual obsessive phenomena, hypochondria, episodic delusional ideas (relationships, jealousy). Personality changes appear in the form of isolation, rigidity, loss of affective flexibility, narrowing of emotional reactions. The circle of interests and acquaintances is limited. There is distrust, gloominess. There may be short-term episodes of anxiety, anxiety, while there are fragmentary statements about their suspicions. The duration of this period is from 5 to 20 years.

With the development and aggravation of the disease, hallucinatory-paranoid phenomena (Kandinsky-Clerambault syndrome), delusional disorders begin to predominate in the clinical picture. With the predominance of delusional disorders in the initial period of the disease, paranoid disorders come to the fore; in the hallucinatory variant, this period is characterized by neurosis- and psychopatho-like disorders. The development of delusional or hallucinatory syndromes can be gradual and gradual. Exacerbations are frequent, the course of the disease is undulating.

With the subsequent development of a hallucinatory syndrome, against the background of episodic ideas of attitude, jealousy, persecution, or neurosis-like phenomena, verbal illusions appear, a delusional interpretation (reference to oneself) of someone else's speech. Then these phenomena are replaced by elementary hallucinations (noise, whistling, hail, words), and even later by true verbal hallucinations with the nature of hallucinosis in the form of a hallucinatory monologue (dialogue), imperative hallucinations. The content of "votes" is most often hostile. The duration of this period of the disease is up to a year.

Further, the Kandinsky-Clerambault syndrome develops rapidly with a predominance of pseudohallucinatory disorders. Fear, anxiety, confusion, elements of acute delirium develop. Acute phenomena pass and the Kandinsky-Clerambault syndrome comes to the fore: a symptom of openness, ideational automatisms (withdrawal, insertion, suggestion of thoughts, impact on memory), senestopathic automatisms (caused by sensations, effects on internal organs). Last of all, motor automatisms develop (violent movements caused by someone else's influence). At the height of the development of the syndrome, depersonalization is expressed - alienation, verbal pseudohallucinosis. The duration of this period is 6-10 years. Then a hallucinatory paraphrenia develops with a fantastic content of delirium, with a hallucinatory character. Accession of "secondary" catatonic disorders is noted in isolated cases.

With the delusional type of the course of the disease, from the moment of the onset of the manifestation, delusional-type disorders predominate.

Often continuously - a progressive course is clinically expressed in the subsequent change of paranoid, paranoid and paraphrenic syndromes. Paranoid syndrome is characterized by interpretive delusions (persecution, jealousy, hypochondriacal, love). There are no hallucinations. General coarsening, paradoxical thinking and speech, autism. The delirium is sketchy, there may be elements of erotic delirium. The appearance of the paranoid stage, that is, the development of the Kandinsky-Clerambault syndrome, is preceded by a short-term, island-like, anxious-fearful state: patients can be agitated, feel fear, they say that they do not understand well what is happening to them. Then the excitement subsides and the Kandinsky-Clerambault syndrome develops. Periodically occurring exacerbations with a deepening of the syndrome are characterized by states of anxiety-fearful excitement.

Sometimes in its dynamics, the Kandinsky-Clerambault syndrome takes on the character of a "positive impact": patients begin to tell that they are pleased with the impact, that it is done in order to please them. Episodic anxious and fearful mood disappears and becomes upbeat. After some time, a new state may appear - the so-called. inverted psychotic automatism. Patients "suddenly discover" that they themselves are able to influence others, force them to do certain things. The appearance of this disorder indicates the development of a transitional stage into a paraphrenic state. In this condition, patients may develop expansive, pseudo-hallucinatory and confabulatory paraphrenia, as well as the transition of one form of paraphrenia to others.

The final state is characterized by discontinuity, neologisms, fragments of the past paraphrenic delirium often slip in the speech of patients, catatonic manifestations are also possible.

Sluggish flowing (neurosis-like) schizophrenia. Personality changes develop gradually, not to the point of deep emotional devastation. Characteristically: neurosis-like states, overvalued ideas, paranoid delirium. Lasts for years. Initial period: signs of distortion and exaggeration of mental disorders (puberty). Then affective, psychopathic disorders, thought disorders, depersonalization phenomena join. The personality changes qualitatively, a sharp drop in the "energy potential" (irritability, isolation). Neurosis-like disorders: obsessive, astheno-hypochondriac, depersonalization, hystero-like. Obsessive disorders occur in the form of phobias and monotonous motor and ideational rituals. Further, there is a gradual, very slow deepening of personality changes in the form of emotional flattening, loss of mental activity. Crazy ideas become permanent, delusional syndromes unfold (paraphrenic, Kandinsky-Clerambault). Violations of mental development in the form of mental infantilism.

Aggravation is a sharp increase in obsessive phenomena, the appearance of depressive-sensitive ideas and ideas of persecution, anxiety, depression. Or affective symptoms predominate. The clinic may be dominated by asthenic-hypochondriac and senestopathic disorders: asthenia or hypochondriacal-synestopathic syndrome. Asthenic disorders are manifested as a violation of thinking with a slight mental load. Affective disorders - constant dysphoric mood coloring, joylessness, then depersonalization joins. Personality changes are clear, consciousness of the disease is preserved. Hypochondriacal phenomena are observed in the form of monotonous, elaborate senestopathies.

There is a feeling of a change in the face, figure, patients look at themselves (symptom of a mirror), convinced of their defect. Hysterical manifestations are revealed in the form of puerilism, pseudodementia, hysterical seizures, hysterical fantasies with a pale affective color. At later stages, personality autization, alienation, a decrease in mental productivity, difficulty in adapting, and loss of contacts join. Overvalued delusions (jealousy, reformism, love, hypochondriacal, sensitive delusions of relationships), there may be a transformation of such delusions into delusions of persecution, which is very rare in progressive schizophrenia. The prognosis of this form of schizophrenia is the most favorable.

Periodic schizophrenia

Periodicity with emerging clearly defined attacks of the disease is characteristic. Attacks are extremely polymorphic in nature, from purely affective to catatonic, with clouding of consciousness. And various delusional disorders, hallucinatory and pseudo-hallucinatory phenomena sharply distinguish them from the typical affective phases of manic-depressive psychosis. It is difficult to predict the nature of subsequent attacks of the disease; they increase with an increase in the depth of the disorder in brain activity.

The initial period of the attack is the instability of affect. The mood is elevated with high self-esteem, with hyperactivity; sometimes subdepressive with lethargy, distraction, resentment, overvalued ideas, fears of a sensitive nature, a feeling of inferiority. Insignificant real conflicts acquire an overvalued sound. These phenomena occur in combination with headaches, discomfort in the heart, parasthesia, sleep disorders. With depression, anorexia, nausea, constipation, hyperthermia are observed. Agitation, insomnia, fear, anxiety, delusional mood with a characteristic feeling of a change in one's own "I" and the environment gradually increase. In some cases, fears remain vague, in others, there are pictures of acute paranoid with delusional behavior. There may be "clearings" with the appearance of criticism, followed by a new influx of delusional fears; orientation is not affected. With the deepening of the attack, delirium of insinuation develops with false recognitions, ideational automatisms, the activity of the imagination sharply increases, which leads to the appearance of paraphrenic modified delirium.

All symptoms take on a fantastic content, fantastic memories are observed, previous knowledge of what is happening around and changes in the body. The perception is delusional, but already with a fantastic character of interpretation. Motor disturbances join in the form of either general lethargy, or enthusiastic gestures and rapid speech.

Further, the oneiroid syndrome intensifies with dreamlike fantastic delirium, detachment, catatonic disorders. Oneiroid-catatonic syndrome is the culminating stage of the attack. There may be a deep clouding of consciousness. The duration of the stages of the attack is different.

Seizure types:

1. Oneiroid-catatonic type. Pronounced catatonic disorders. Oneiroid clouding of consciousness. Affective disturbances are labile; fear, ecstasy in the first place. The exit of their attack is critical.

2. Oneiroid-affective type. Oneiroid obscurations of consciousness are expressed. Persistent depression or manic state.

3. Oneiroid-delusional type. The development of delusions, from acute sensual to fantastic. Verbal pseudo-hallucinations. Phenomena of mental automatism.

4. Depressive-paranoid type. depressive content.

Delusional disorders.

Personality changes in this type of schizophrenia appear after repeated attacks. Phenomena of mental weakness are expressed in a decrease in mental energy (activity, initiative, interests, limitation of contacts. The consciousness of one’s change, the painful nature of one’s passivity is preserved. energy). In other cases, it is overvalued in relation to one's mental health, with the desire to create a special regime of work, rest, treatment, with features of mental rigidity. Under the influence of therapy, seizures are easier. With the early appearance of individual delusional ideas in the picture of seizures, or with Significant severity of hallucinatory and pseudo-hallucinatronic disorders, personality changes are characterized by true autism and emotional flattening.

Fur coat schizophrenia

Signs of a continuous sluggish course and distinct seizures, similar to seizures in periodic schizophrenia (hence this type of schizophrenia is called "mixed"). In the initial period, neurosis- and psychopath-like disorders, after one or more acute attacks (affective or affective-delusional), are replaced by paranoid, and sometimes paranoid disorders. Neurosis-like and delusional disorders are fragmentary, poorly systematized. Personality changes are less gross, but they are much more distinct. Acute attacks are characterized by a protracted nature, a combination of both affective and catatonic phenomena, and delusional ideas with the nature of persecution, pseudohallucinations. From attack to attack, the picture becomes more complicated. Under the influence of therapy, it can be reduced, being exhausted by affective disorders (more often depression). In favorable cases, the course of the disease is sluggish for a long time, with constant neurosis-like disorders and "pure" depressive attacks. With an unfavorable course, frequent, complex in structure attacks are noted with the transition after one of the exacerbations to a continuous course.

The prognosis depends on the age of onset of the disease, the severity of the process and the degree of personality change.

Biological methods (shock therapy, psychopharmacotherapy). Preparations:

1. psychoanaleptics (antidepressants)

2. psycholeptics

3. tranquilizers

They are used in courses, for the relief of exacerbations, on an outpatient basis and in the form of maintenance therapy. The choice of the drug depends on the structure of the psychopathological syndrome, which determines the exacerbation clinic by the time the treatment is started.

4. insulin therapy

5. electroconvulsive therapy

Due to the structural complexity of the syndromes, it is necessary to use combinations of various psychotropic drugs. In the treatment of progressive continuously flowing forms, chlorpromazine 300-500 mg per day is used. The same is true for febrile seizures. In case of intolerance to chlorpromazine IV sibazon or stelazin 30-80 mg per day. With catatonic disorders, etaperazine 20-90 mg per day, mazheptil 15-60 mg per day. For delusional and hallucinatory disorders, haloperidol 5-30 mg per day, levomepromazine (tisercin) 150-200 mg per day.

In depressive states, sedative antidepressants (nosinane, amitriptline) are used. With sluggish processes and with maintenance therapy, we connect Librium (Elenium), Meprotan, Valium. With negative disorders - neuroleptics.

Insulin, a course of 15-20 coma is used for periodic forms of schizophrenia, often in combination with psycholeptics. Insulin-shock therapy is also indicated for patients with acute manifestations of the schizophrenic process and somatically weakened, and electroconvulsive therapy for patients who are resistant to therapy by other methods, and with chronic depressive states. Due to the widespread use of psychotropic drugs, a significant number of patients are treated on an outpatient basis.

Prevention of schizophrenia

Prevention is one of the most important tasks of psychiatry. Primary prevention of schizophrenia is currently limited to medical genetic counseling. The risk of the birth of sick children from parents with schizophrenia is being clarified. For secondary prevention measures, medical and rehabilitation means are used. With early detection of the patient, timely treatment with the appointment of maintenance therapy, it is possible not only to prevent the development of severe mental disorders, but also to preserve the opportunity for the patient to stay in society and family.

Indications for hospitalization:

1. All the first manifestations of psychosis with a lack of consciousness of the disease.

2. Psychotic exacerbations that require the use of high doses of psychotropic drugs.

Depressive states that occur in schizophrenia more often in a mixed type require special vigilance, and in which the risk of suicidal tendencies is extremely high. Long-term inpatient treatment in specialized units is necessary for patients with end conditions due to the great difficulty of caring for and supervising them at home.

Caring for people with schizophrenia

To ensure the stability and effectiveness of the patient's social and professional adaptation in life, measures of social rehabilitation are necessary. The approach to the rehabilitation of patients with schizophrenia should be individual and differentiated. Depending on the patient's condition, rehabilitation measures are carried out in hospital or out-of-hospital conditions. The options for hospital rehabilitation primarily include occupational therapy in hospital workshops, cultural therapy, intra-departmental and hospital-wide social events. Further, it is possible to transfer patients to a department with a light regimen, such as a sanatorium or a day hospital. It is advisable to carry out rehabilitation measures according to the method of a single comprehensive program, especially in cases where the patient needs to instill any new or restore old labor skills. A large role in the outpatient rehabilitation of a patient with schizophrenia belongs to the doctors of the district neuropsychiatric dispensary. Rehabilitation, which is carried out at work, can significantly reduce the number of socially maladjusted patients with schizophrenia. However, the success of rehabilitation measures largely depends on the combination of labor activity and regular maintenance therapy.

schizophrenia mental illness

References

1. Small medical encyclopedia.

2. N.M. Zharikov "Psychiatry".

3. Adolescent medicine.

4. E.F. Kazanets "The Mystery of Schizophrenia".

5. A.A. Kirpichenko "Nervous and mental diseases".

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As can be seen from the foregoing, schizophrenia in the proper sense is an endogenous disease based on a hereditary predisposition, usually developing from within without external shocks, characterized by a general change in the entire mental personality with the character of a decrease in tone, with a loss of unity, from the outside manifesting itself in isolation, fenced off from the outside world. , with a tendency to decrease intelligence. Clinical symptoms in this case are extremely diverse. It includes almost everything that was stated in the chapters containing a description of the phenomenology of psychosis in general. On the other hand, in relation to schizophrenia, more than to any other disease, it is true that for the characteristic it is not one symptom that matters, and not even a combination of them, but, so to speak, the features of the internal linkage between them. The manifestations of the disease, both in general, from the introductory changes to the initial dementia, and its individual forms include a very large number of symptoms. But if we were to give a detailed and exhaustive presentation of them with their timing to individual periods and painful forms, then this would be only an external description that would not give an idea not only of the essence of the disease, but even of the clinical characteristics. Here, the most important thing is the relationship between individual symptoms, and even more - their relationship with general personality changes, which should be considered the basis of all changes that occur. Each symptom acquires significance only in connection with an assessment of the general changes that develop in the psyche and change its entire structure. Under such conditions, in order to get acquainted with the essence of schizophrenia, it is precisely the elucidation of these general changes in the entire mental personality, the change in the entire mental appearance, in other words, the study of the psychology of schizophrenia, that acquires special significance. Familiarization with its features and differences both from a healthy psyche in general, and from what the patient represented before the disease, can most of all give an understanding of this disease. Penetration into the psyche of a patient with schizophrenia is the only thing that can give the key to understanding both individual symptoms and their totality and the behavior of the patient as a whole.

At the center of the schizophrenic psyche lies a peculiar change in the consciousness of the “I” itself and the whole personality with a violation of normal attitudes towards the environment. First of all, it is characterized by more and more prominent isolation in itself, alienation from everything else. In the presence of this autism, the patient's personality acquires more and more the meaning of something self-sufficient, finding in itself everything that is needed to maintain a certain balance, and not needing any excitations from the outside. From the outside, this autism is expressed in isolation, in increasing alienation from the environment with some active resistance to attempts from the outside to break this isolation and make contact with the patient. According to the internal mechanisms of development, autism stands in connection with other features of the schizophrenic psyche, and above all with the cardinal phenomenon that gave the name to the whole disease - the splitting of the psyche. The latter lies in the fact that the elements of the psyche turn out to be disparate, not united into one harmonious whole, but as if existing separately on their own. This, in turn, is due to the weakening of mental activity, which is reflected in the insufficient activity of synthesis and in the insufficient processing of external impressions.

Fencing off from the outside world finds a direct explanation for itself in the biological changes that are constantly observed in schizophrenia. In this regard, first of all, the absence, or at least a more or less significant weakening of the reflexes of the skin and mucous membranes, which are, as you know, a kind of protective mechanisms, deserves attention, which is typical for schizophrenia. Such features do not represent an isolated phenomenon, but are a partial case of a general weakening of the ability of the schizophrenic brain to respond to external stimuli.

For example, it is a common phenomenon that schizophrenics have mild reactive phenomena to intoxication and infection. In this regard, with a quite pronounced disease, infections for the most part proceed without delirium. Phenomena of the same order also include the fact that the formation of conditioned reflexes to any stimuli in schizophrenics is given with great difficulty, and already established reflexes fade relatively quickly. All this speaks for the fact that in patients of this kind there are some objective conditions due to which contact with the environment and the liveliness of response to stimuli coming from outside are violated. In part, here one has to reckon with the peculiar innate features of the mental organization, since the phenomena of autism can often be ascertained long before the discovery of the disease, but there is no doubt that with its onset, all previously outlined signs intensify, in particular autism. In some cases, the development of autism is facilitated by peculiar phenomena of mental hyperesthesia, a special sensitivity that makes close contact with others unpleasant for the patient and makes him especially close and fence off. Naturally, autism and its external expressions - isolation and low sociability of the psyche - represent something much deeper and more persistent than the reluctance of a normal person to communicate with others, caused by emotional moments. The splitting of the psyche is the biological basis not only for autism, but also for other symptoms that are also considered basic for this disease. Due to the fragmentation of individual elements related to the same phenomenon, but not united by schizophrenic thinking, it happens that all of them, including those that contrast with each other, exist independently, independently of each other. Under normal conditions, each new phenomenon, in relation to which a person must take one position or another, eventually finds a common and unified assessment for itself, which determines the line of behavior in relation to it. In every more or less complex phenomenon there are always many different aspects, a lot of signs, diverse in nature and degree of expression. The normal psyche, taking into account all the individual moments, weighs pro and contra, draws a definite conclusion, by which it is guided in its behavior. In a schizophrenic, this unifying thinking is very weak, and the individual elements do not merge into one whole, and each tends to give a reaction that is adequate only to him.

It seems to patients that one or the other side of any phenomenon is important, and therefore they often change their attitude to it many times over. This is most clearly expressed in the presence of two sides opposite in nature, one of which attracts, and the other repels. For example, when greeting a doctor, such a patient alternately stretches out his hand, then immediately takes it back, and so on many times; entering the study room, he stops, then takes a step forward, then steps back, and so on ad infinitum. Naturally, for such simple acts as shaking hands and visiting an office, many different motives can be imagined for both positive and negative solutions to the issue. The usual reaction for healthy people and for most patients is - without hesitation to offer a hand and accept the invitation. Psychologically understandable would be a consistently negative reaction in a patient with delusions of persecution in relation to the doctor or with delusional attitudes towards others in general. But in this case, there is both a positive and a negative assessment of the same phenomenon and at the same time opposite tendencies - to reach out, enter the office and do just the opposite. This phenomenon is called ambivalence and ambivalence, with the first name referring to the characteristics of intellectual components, and the second - the impulses to action associated with them. To a greater or lesser extent, this ambivalence is characteristic of all schizophrenics. Although in such a sharp form as in the examples given, it does not appear very often, nevertheless, it must be seen as the reason that the whole behavior of the schizophrenic turns out to be devoid of unity, consisting of disparate and often contradictory acts; even more often it is revealed in the fact that the schizophrenic, not being able to make the final choice among the solutions presented, remains inert, inactive, completely passive in his attitude to the environment.

Schizophrenic ambivalence and ambivalence differ in essential features from the uncertainty in one's actions and indecisiveness, characteristic of psychasthenics and neurotics in general. From the side of internal experiences, the indecision of psychasthenics is characterized by great emotionality and a completely different attitude towards it by the patient himself: he is aware of its absurdity, is tormented by it, strives to overcome it, but cannot; the schizophrenic is passively carried away by those ideas that are currently dominant. From the outside, the manifestations of ambivalence and ambivalence are coarser, more stubborn, manifesting themselves not only in complex actions, in relation to which there may be doubts about the correctness of one or another approach, but also in the most elementary motor acts, the fulfillment or non-fulfillment of which even to the smallest extent. cannot interfere with the patient's interests in any way. The behavior of an ambivalent schizophrenic can sometimes give the impression of complete absurdity and dementia, but the latter in the proper sense is not here. The possibility of a correct understanding of phenomena and adequate behavior is not excluded, but it is not revealed due to some internal reasons. This latter can sometimes be interpreted as a phenomenon of inhibition, close to what is called by this name among physiologists. Not without reason IP Pavlov brings together some clinical phenomena with inhibition. Undoubtedly, however, that in its main basis, the phenomena in schizophrenia are much more complicated. It must be considered that the German psychiatrist Beringer, who speaks of the weakening of the intentional arc in the thinking of the Schizophrenic, is closer to the truth, and Berze, according to which the most significant thing in schizophrenia is a general decrease in mental activity, due to which the possibilities that are available are not revealed, and more highly standing mental forces are affected. , in other words, higher mental abilities. It is precisely because of the lowering of psychic activity concerning higher processes that the phenomena that characterize the life of the lower aspirations and instinctive drives that are suppressed in the ordinary state are predominated. However, the state of affairs cannot be imagined in such a simplified way that we are talking about the disinhibition of impulses coming from the subcortical zone as a result of the disinhibition of the cortex, with the activity to which higher mental processes are usually associated. Undoubtedly there are deeper changes in the whole psychic personality. The latter seems to the schizophrenic connected with the surrounding by some special relationship. There is some analogy in this with the thinking of primitive man, as Levi Bruhl describes it. Everything around is perceived by the schizophrenic as having a certain relation to him, is perceived in a special symbolic way, from the point of view of some mysterious connections with the environment, some magical influences, the object of which is he and his body. The thinking of a schizophrenic in this way is not adequate to the thinking of a normal person, which is why it is often called paralogical, going, as it were, according to its own laws, different from all the laws that can be seen in the thinking of a healthy person. They also talk about abstraction”; abstractness of thinking of a schizophrenic, standing in connection with his detachment from the external real world and internal aspiration, introvertedness in Jung's terminology.

The splitting of the psyche usually concerns such formations that are the most durable, in particular, the consciousness of the patient's "I" itself. The latter in a normal state is characterized by a number of signs, which include activity, unity, continuity and consciousness that these experiences belong to the subject, are his personal, the “I” of the schizophrenic is deprived of all these properties and, above all, unity. It seems completely different, substituted, devoid of its usual properties. Related to this is the fact that schizophrenics sometimes refer to themselves in the third person. This affirms, first of all, the presence of deep changes in the consciousness of one's "I" and, moreover, with a clear splitting off of some elements of the personality from others: the "I" observing - the central part - receives the meaning of something independent and independent of the "I" acting. This can be seen already manifestations of the most essential schizophrenic symptom - split personality, sometimes leading to the idea that two, as it were, separate people live in the patient, who are in a certain antagonism: one acts, the other criticizes, condemns or defends. Sometimes the patient himself identifies himself with one of these two personalities, sometimes they seem to exist completely independently of him. Going even further, splitting can turn the personality into a disorderly collection of scattered fragments, and the result is a complete disintegration of the personality, in which it is difficult to catch hints of the former structure. Due to the fact that the experiences of the patient lose the character of something personal, belonging to him, individual ideas or groups of them begin to seem like something alien, extraneous, inspired from the outside.

The described changes in the personality of schizophrenics are in some respects reminiscent of the depersonalization of melancholics, to whom their "I" also seems changed, completely different, lifeless and insensitive. In this case, however, there is no violation of the unity of the personality: and its continuity: the melancholic does not think about the existence of some other person, but expresses his conviction that his own personality has changed, and he blames this change. Meanwhile, in a schizophrenic, all phenomena are much more crude, they have the character of complete splitting, disintegration. To a certain extent, a change in organic sensations is common, which is quite profound in melancholics. Although it has a different character there, the main differences are not in emotional experiences, but in intellectual disorders that come to the fore in schizophrenia, are accompanied by a profound violation of the mental structure, while the personality of the melancholic in its essence is completely unchanged, which is especially clear. performs after the attack of the disease; after an illness, the personality of a melancholic comes out the same, not damaged in its basic properties.

The change in sensations associated with the activity of the organs of the body is a constant and essential feature of great importance for the genesis of many phenomena characteristic of the psychology of schizophrenics. In relation to schizophrenia, more than in relation to any other psychosis, the general position holds that psychosis is a disease of the whole organism, and not just of the brain. Naturally, therefore, the appearance in the mind of a schizophrenic of new, abnormal sensations, acting on well-being and emanating from the internal organs. But it must be borne in mind that with this disease, changes in the subcortical zone and, in particular, in the centers of the autonomic nervous system, are very frequent. As a result of deep autonomic disorders associated with changes in the corresponding parts of the central nervous system, schizophrenics in large numbers have various sensations of a usually unpleasant nature, paresthesia, sensations of sorting, pulsation, passage of electric current, sometimes quite pronounced pain. According to the statistics of the psychiatric clinic II MMI, out of 65 cases of schizophrenia, 52 had sharp headaches, and the rest had a feeling of heaviness and tension. Bleuler pointed out the frequency of headaches in schizophrenia. In many cases they are of a special nature, resembling similar phenomena in migraine, partly in brain tumors. Headaches are undoubtedly associated with vasomotor and secretory disorders, sometimes with those changes that are known under the name of cerebral swelling (Hirnschwellung) and are very often ascertained in the autopsy of schizophrenics.

Most patients complain not so much of pain as of a feeling of fullness, swelling of the brain. It seems to them that the brain grows, swells, enlarges, fills the entire skull, presses on the bones ready, they protrude, unclench, diverge. Patients feel that the head is under some kind of pressure, that at any moment it can burst, tear; from within, something presses on the eyes, on the superciliary arches, as a result, the eyes, according to the expression of the patients, roll out, the superciliary arches and temples protrude. One of the patients, at the moment of severe pain, ties a towel around her head in order to keep the bones in place in this way. Pain is always felt to come from within. The very brain hurts, an abscess is definitely brewing in it, which pulsates, presses and presses.

Against the background of various sensations, which are very frequent in schizophrenia, illusions develop in large numbers, which, together with hallucinations, play a large role in the pathology of this disease. It seems to the patient that someone is touching him, someone is lying behind his back on the same bed with him. Illusions of a general feeling should include such sensations as if inside, in the abdominal cavity, in the chest, in general, there is something extraneous, alive in the body. Hallucinations are much more important. Inclination to them, some psychiatrists are among the main signs of schizophrenia. Especially often observed, and, moreover, in a characteristic form, olfactory and auditory hallucinations. In part, here we have to reckon with the phenomena of hyperesthesia, which are the same signs of irritation as the above-described unpleasant and painful sensations. If we recall that, for example, Halban (Halban) stated in pregnant women a significant increase in the acuity of perception of mainly olfactory and gustatory sensations, then something similar can take place here. In any case, schizophrenics have very frequent hallucinations in the proper sense. The patient is haunted by various smells, mostly of an unpleasant nature: the smell of burning, rotten eggs, carrion, the smells of some unknown poisons, the smell of sweat, urine and feces. Often it seems to the patient that the bad smell comes from himself.

Taste hallucinations are most often in such a form that some strange taste of something metallic, some kind of poison seems to be in the food; the meat in the soup has a taste of carrion, some kind of rot. Auditory hallucinations are most often observed in the form of voices, which are either single or numerous and are heard from all sides. The voices are either loud, real and heard so clearly that you can indicate the direction from which they are coming, then almost silent, heard in the form of a whisper. Sometimes the patient cannot tell where the voices come from, in some cases the voice or voices are heard inside the patient himself, in the chest, especially often in the head. The so-called inner voices and "opinions" are especially characteristic. It seems to the patient that, although he does not hear anything, someone is talking directly into his head. Typical for this disease are those phenomena that are known under the name of pseudo-hallucinations or mental hallucinations, as well as the fact that his thoughts and individual words seem to be repeated loudly by someone (Gedankenlautwerden). Sometimes patients talk about the telephone, wireless telegraph, radio.

The content of hallucinations is mostly unpleasant for the patient; he hears abuse, threats addressed to him, he is accused of various crimes in his service, in a bad attitude towards his family, in debauchery. Sometimes he hears long discussions in which a large number of people take part, the whole past life of the patient is discussed, and it is found that he has always been a bad person, a thief, an onanist, a state criminal, a spy. Sometimes voices are heard that stand up for him. Sometimes dialogue is heard; two voices arguing among themselves, and both are localized inside the head of the patient. Most often, the speakers do not address the patient directly, but, as it were, talk about him among themselves, calling him by name or simply “he”. Quite typical of schizophrenia are auditory hallucinations of this kind that a voice belonging to an invisible person registers everything that the patient does, mocking and scolding, for example: “Now he undresses and goes to bed, now he will sleep,” etc. In some cases, the hallucinatory experiences of schizophrenics generally take on the picture of Clerambault's mental automatism. Most of the voices belong to strangers, less often to familiar people whom the patient does not see. Sometimes it seems to the patient that the voices he hears belong to those around him, passers-by on the street, random companions in the tram.

Less common are visual hallucinations, which are also varied. A feature of the visual hallucinations of schizophrenics can be considered that they are mostly devoid of brightness and vitality. Hallucinatory images are somehow incorporeal, unreal, give the impression of painted pictures, and not creatures of flesh and blood. Sometimes the figures move like in a movie. Similarly to auditory deceptions of the senses, pseudohallucinations often occur here too - certain images are seen somehow mentally and appear to lie somewhere outside the field of vision, sometimes in the head.

Acquaintance with the content of the hallucinations of schizophrenics, even the very proof of their presence, presents great difficulties due to the autistic attitudes of such patients, low sociability and even a tendency to hide their experiences due to the tendency to dissimulate. In such cases, one has to be guided by an assessment of the general behavior of patients and the so-called objective signs of hallucinations: a close look at one point, turning the head, making one think that the patient is listening to something, pinching his nose, plugging his ears, etc. (Fig. 39 ).

Rice. 39. Plugging the ears of a schizophrenic with auditory hallucinations.

Sometimes the presence of hallucinations can be judged by unexpected quick movements, shouting out answers to someone in space, refusing food.

Among the characteristic phenomena in schizophrenia, delusional ideas should also be attributed. Although they do not represent an absolutely constant symptom in this disease, but where they occur - and such cases are still the majority - in their structure, in which one can see a clear reflection of the main points of schizophrenic thinking in general, they are a very important ingredient in the clinical picture. The exact clarification of their nature is of great importance for understanding the essence of the disease and for distinguishing it from other diseases. This refers not so much to their content, but to the mechanisms of development, construction and the role that they play in the life of the patient and in relation to others. In the sense of the genesis of delusional ideas, the defining moment is a change in the patient's well-being, the presence of a large number of various new sensations in the body, illusions and hallucinations, as well as disorders in the intellectual sphere. The most characteristic for schizophrenics is, according to the terminology of the psychiatric clinic II MM And cathestic delusions, that is, one where the main role is played by a change in the world of sensations in which the patient lives. Various sensations experienced by him in the body, pain in different places, a feeling of something extraneous, disorders of taste, smell and other sensations - all this in a certain way affects the perception of the environment. In connection with the decrease in critical and combining activity, delusion develops on this basis, which naturally should take the form of a delusion of physical influence. The sensations that appeared as a result of biological changes in the body and, in particular, disorders in the autonomic nervous system, together with illusions and hallucinations, provide material for delusions of poisoning, exposure to electric current, delusions of suggestion, in general, various forms of physical influence. Experiencing changes throughout the body and not being able to take them critically and evaluate them as a result of the disease, the schizophrenic projects the cause of this change outward and sees it in some influences of other people. The isolation of such patients, together with a violation of contact with others, deprives the patient of the opportunity to become more fully acquainted with all aspects of the phenomenon, which in some initial cases could give a certain correction of emerging delusional ideas, and at the same time, it is the reason that delusional formation occurs within a vicious circle. autistic experiences of the patient, out of touch with the surrounding real life, why delusion, when detected, strikes with its strangeness, surprise, as if contrived and inconsistency with the real situation. Patients become somehow especially distrustful and suspicious. It seems to them that those around them have begun to treat them differently, shun the patient, whisper among themselves, laugh at him; on the street and in the tram one and the same suspicious faces constantly come across, some strange taste is noticed in the food. For some time, the matter is limited only to alertness and, as it were, keeping an eye on what is happening around, and we can talk about a special period of incubation, during which crazy ideas seem to be nurtured; then the patient has a certain conviction that his suspicions are well founded. Due to the isolation of schizophrenics and suspicion towards everyone around them, fully mature crazy ideas, as a rule, are not expressed for a very long time, they even stubbornly hide. In the presence of a well-defined delirium, direct questions about the patient's attitude to persons woven into this delirium usually receive evasive or even negative answers. With a strong tendency to dissimulate, the patient very often stubbornly and with great skill hides his delusional attitude towards imaginary enemies and behaves towards them in such a way that the latter may not suspect anything for a long time. This can happen even to the people closest to the sick person who constantly live with him and it would seem that they should know his psychology. So in one case, a schizophrenic, in connection with the development of a delusion of jealousy in him at the beginning of his illness, made an unexpected attack on his wife, which almost ended in a serious misfortune, although before that he had not shown any hostile attitude towards her.

A very common form of delusions of persecution in schizophrenics is delusions of suggestion, influence. It seems to the patient that he is completely subordinate to some people unknown to him, in the power of some special force, that all his thoughts and actions are not his, but inspired by others. He himself is just an automaton, a toy of some mysterious forces. In interpreting the nature of this influence, the patient sometimes speaks of hypnosis, suggestion at a distance, reading his thoughts and suggestion of desires unusual for him, impulses for this or that action, about the action of special rays, about radio, about some special machines. The peculiarities of the delusional concepts of schizophrenics include the fact that the delusion of persecution is very often associated not with people around him and generally known to him, but with some suspicious, unknown personalities. This feature is especially pronounced when the delusions are extensive, complex and, as often happens, tend to add up to a whole system. In such cases, some special mysterious organizations often appear, a gang of intruders, the mafia, masons, counter-revolutionaries. The patient does not know any of these intruders either by sight or by name, but is convinced of their existence, as he constantly feels their influence on himself. The nature of the effects seems so peculiar to the patient that often he cannot define it in generally accepted terms, but must invent special names, sometimes not stopping before inventing new words.

Delusions of grandeur are not so common, but if there is, in its structure it represents all the features of schizophrenic psychology. The content of delirium, as is characteristic of it in general, varies depending on the characteristics of the time experienced, on social status and the education received. From the outside, it is often as if there is a great resemblance to progressive paralysis, since the same ideas of high position, possession of various talents appear, but the inner meaning and psychogenesis are completely different. The schizophrenic's delusions of grandeur lack concreteness and reality; he does not consider himself simply Napoleon, a high commissioner, a famous artist, but characterizes his difference from ordinary people in a special, often vague and not always understandable way. For example, he begins to think that he is a genius who has never had an equal; he is called upon to carry out great reforms, to make all people happy, he invented a special system, massage, which will immediately open the eyes of all people and teach them how to live, so that everyone feels that they do not know sorrow.

It is characteristic that a schizophrenic, when creating crazy systems that seem to be aimed at the benefit of others, always has in mind not specific people close to him and those around him in general, but some abstract person, all of humanity. In this, too, he differs from a paralytic patient who distributes his imaginary wealth to those around him and tries to make happy, first of all, those who have rendered him some service. In self-exaltation, schizophrenia sees the realization of some higher will, the predestination of some mysterious forces. In this regard, it is very typical of the delusions of grandeur of schizophrenics that they often imagine themselves to be prophets, leaders, reformers, destined to show mankind new ways. Very often you can discover in the construction of delirium a tendency towards something mystical, mysterious, towards something special that cannot be measured by an ordinary arshin.

In many cases, delusional ideas of grandeur are observed in a schizophrenic simultaneously with delusions of persecution, sometimes entering the same system, with some ideas representing, as it were, the logical development of others; the patient is persecuted because they envy him, they want to take away his high position from him, to appropriate and pass off as his own inventions, etc.

The delusional ideas of schizophrenics are also characterized by the fact that, being in an organic connection with the foundations of his thinking, they are persistent, not amenable to dissuasion, and to a greater extent are reflected in his behavior. The schizophrenic, despite the fact that he has long retained the formal abilities of the intellect and a store of information, can never be convinced that his suspicions are unfounded or that his claims to high position are absurd. On the contrary, contradictions and objections make patients especially stubborn and force, strengthening their argumentation, to develop delusional concepts more and more. We can further talk about a very large sequence of the patient's behavior from the point of view of his delusional ideas. They determine social attitudes, attitudes towards others, such as the final withdrawal from other people and the creation of complete isolation, as well as the protective measures that the patient takes and attacks on others. In the future, as dementia grows, the delusional concepts lose their integrity and unity, and even further, along with the disintegration of the psyche, they turn into separate fragments, and the expressed fragmentary delusional ideas seem completely meaningless and no longer have any effect on the patient's behavior.

The features of delirium characteristic of schizophrenia come out with particular clarity not when the delirium is generally poorly developed, and comes down, as often happens, to 2-3 more or less interconnected thoughts. They need to be studied in those cases where the development of the delusion leads to the creation of especially magnificent pictures. Particularly interesting from the point of view of influencing behavior are those cases in which insane thoughts and desires arising from delusional fantasies are more or less fully realized in life, without encountering obstacles due to the exceptional position of the patient. In this respect, the history of the disease of the Bavarian king Ludwig, who came from a very degenerate Wittelsbach family, deserves attention.

He suffered from schizophrenia for a number of years with a lot of delusional ideas of greatness and persecution, which did not prevent him from remaining on the throne for some time.

The delirium of persecution and the fear of people led him to spend whole months alone, or at least without seeing a single face. Food was served to him on a table that, with the help of a special mechanism, was pulled out from under the floor. Approximate, being to his reception, had to wear masks. When he visited the court theater, then in the latter there should not have been other spectators except him. He himself sat in a closed box, and it was not visible from the stage or from the spectator shaft whether the king was in his box or not. Artists had to play in an empty theater without being sure that they had at least one audience. For the schizophrenic king, a secluded castle was built according to his instructions, on the lead roof of which a lake was built, an artificial swan floated on it, on which the king, who imagined himself to be Lohengrin, sat down. Such sharp disturbances, however, did not prevent the patient from maintaining sufficient orientation and even cunning. This is evident from the fact that he, having committed suicide under insufficiently clarified circumstances (apparently, drowned in the lake), killed his life physician, the famous psychiatrist Gudden, along with him.

Schizophrenia is a mental illness of a continuous or paroxysmal course, begins mainly at a young age, is accompanied by characteristic personality changes (autization, emotional-volitional disorders, inappropriate behavior), mental disorders and various psychotic manifestations. Frequency- 0.5% of the population. 50% of beds in psychiatric hospitals are occupied by patients with schizophrenia.

Code according to the international classification of diseases ICD-10:

Causes

Genetic Aspects. A priori, polygenic inheritance seems to be the most probable. The unscientific application of a broader definition of schizophrenia leads to an increase in the estimate of the population frequency to 3%. Several loci have been proven or suspected to contribute to the development of schizophrenia (.SCZD1, 181510, 5q11.2‑q13.3; .amyloid b A4 precursor protein, AAA, CVAP, AD1, 104760, 21q21.3‑q22.05; .DRD3 , 126451, 3q13.3; SCZD3, 600511, 6p23; SCZD4, 600850, 22q11‑q13; EMX2, 600035, 10q26.1.

Symptoms (signs)

CLINICAL PICTURE

Clinical manifestations of schizophrenia are polymorphic. Various combinations of symptoms and syndromes are observed.

Negative symptoms. In psychiatry, the term "negative" means the absence of certain manifestations inherent in a healthy person, i.e. loss or perversion of mental functions (for example, depletion of emotional reactions). Negative symptoms - - decisive in the diagnosis.

Thinking disorders. People with schizophrenia rarely have only one type of impaired thinking; usually note a combination of different types of thought disorders .. Diversity. Minor features of ordinary things seem to be more significant than the subject as a whole or the general situation. Manifested by ambiguity, vagueness, thoroughness of speech .. Fragmentation. There is no semantic connection between concepts while maintaining the grammatical structure of speech. Speech loses its communication properties, ceases to be a means of communication between people, retaining only its external form. Characterized by a gradual or sudden deviation in the thought process towards random associations, a tendency to symbolic thinking, characterized by the coexistence of the direct and figurative meaning of concepts. There are sudden and incomprehensible transitions from one topic to another, a comparison of the incomparable. In expressed cases, speech is devoid of semantic meaning and is inaccessible to understanding with its outwardly correct construction. In pronounced cases of broken thinking, the patient spews out a sequence of completely unrelated words, and pronounces them as one sentence (verbal okroshka). The disorder occurs with a clear mind, which is different from an absence. The patient starts his thought or answer and stops suddenly, often in the middle of a sentence. .. Reasoning - thinking with a predominance of ornate, little content, empty and fruitless reasoning, devoid of cognitive meaning .. Neologisms - new words invented by the patient, often by combining syllables taken from different words; the meaning of neologisms is clear only to the patient himself (for example, the neologism "tabushka" is created from the words "stool" and "wardrobe"). For the listener, they sound like absolute nonsense, but for the speaker, these neologisms are a kind of reaction to the inability to find the right words.

Emotional disorders. Emotional disorders in schizophrenia are manifested primarily by the extinction of emotional reactions, emotional coldness. Patients, due to a decrease in emotionality, lose a sense of attachment and compassion for loved ones. Patients become unable to express any emotions. This makes it difficult to communicate with patients, leading them to withdraw even more into themselves. In patients at a later stage of schizophrenia, strong emotions are absent; if they appear, one should doubt whether the diagnosis of schizophrenia was correctly made. Emotional coldness first of all and to the greatest extent manifests itself in feelings for parents (usually the patient responds to the care of the parents with irritation; the warmer the attitude of the parents, the more obvious the patient's hostility towards them). As the disease progresses, such a dulling or atrophy of emotions becomes more and more noticeable: patients become indifferent and indifferent to the environment. great care. Patients with schizophrenia show both positive and negative emotions, although not as strongly as healthy people. Some people with schizophrenia who appear to be emotionless actually live rich emotional inner lives and take their inability to express emotions hard. Ambivalence. The coexistence of two opposite tendencies (thoughts, emotions, actions) in relation to the same object in the same person at the same time. It is manifested by the inability to complete certain actions, to make a decision.

Volitional disorders. Emotional disorders are often associated with decreased activity, apathy, lethargy and lack of energy. A similar picture is often observed in patients suffering from schizophrenia for many years. Pronounced volitional disturbances lead to unconscious removal from the outside world, preference for the world of one's own thoughts and fantasies, divorced from reality (autism). Patients with severe volitional disorders look inactive, passive, lack of initiative. As a rule, emotional and volitional disorders are combined with each other, they are designated by one term "emotional-volitional disorders". For each patient, the ratio of emotional and volitional disorders in the clinical picture is individual. The severity of emotional-volitional disorders correlates with the progression of the disease.

Personality changes are the result of the progression of negative symptoms. Manifested in pretentiousness, mannerisms, absurdity of behavior and actions, emotional coldness, paradoxicality, lack of sociability.

positive (psychotic) manifestations. The term "positive" ("productive") in psychiatry means the appearance of states that are not characteristic of a healthy psyche (for example, hallucinations, delusions). Positive symptoms are not specific for schizophrenia because occur in other psychotic conditions (eg, organic psychosis, temporal lobe epilepsy). The predominance of positive symptoms in the clinical picture indicates an exacerbation of the disease.

Hallucinatory - paranoid syndrome is manifested by a combination of poorly systematized, inconsistent delusional ideas, more often persecution, with a syndrome of mental automatism and / or verbal hallucinations .. For the patient, apparent images are as real as objectively existing ones. Patients really see, hear, smell, and do not imagine. For patients, their subjective sensory sensations are just as real as those coming from the objective world. The behavior of a patient experiencing hallucinations seems insane only from the point of view of an outside observer; The most important and common symptoms of schizophrenia, however, one symptom is not enough to diagnose this disease. Many patients with schizophrenia with a whole range of other symptoms, such as thought disorders, emotional and volitional disorders, have never observed either delusions or hallucinations. It must also be remembered that delusions and hallucinations are inherent not only in schizophrenia, but also in other mental illnesses, so their presence does not necessarily indicate that the patient has schizophrenia.

Syndrome of mental automatism (Kandinsky-Clerambault syndrome) is the most typical variety of hallucinatory-paranoid syndrome for schizophrenia. The essence of the syndrome is the feeling of the violent origin of disorders, their "made" .. Alienation or loss of belonging to one's "I" of one's own mental processes (thoughts, emotions, physiological functions of the body, movements and actions performed), experiencing their involuntary, made, imposed from the outside. Symptoms of openness, withdrawal of thoughts and mentism (an involuntary influx of thoughts) are characteristic. impact. Patients no longer belong to themselves - they are at the mercy of their persecutors, they are puppets, toys in their hands (feeling of mastery), they are constantly under the influence of organizations, agents, research institutes, etc.

Paraphrenic syndrome is a combination of expansive delusions with delusions of persecution, auditory hallucinations and (or) mental automatisms. In this state, along with complaints about persecution and influence, the patient expresses ideas about his world power, cosmic power, calls himself the god of all gods, the ruler of the Earth; promises a paradise on earth, the transformation of the laws of nature, a radical climate change. Delusional statements are distinguished by absurdity, grotesqueness, statements are given without evidence. The patient is always in the center of unusual, and sometimes grandiose events. Observe various manifestations of mental automatism, verbal hallucinosis. Affective disorders manifest themselves in the form of elevated mood, capable of reaching the degree of a manic state. Paraphrenic syndrome, as a rule, indicates the prescription of the onset of schizophrenia.

Capgras Syndrome (delusional belief that people around them are able to change their appearance for a specific purpose).

Affectively - paranoid syndrome.

Catatonic syndrome. Catatonic stupor. Characterized by increased muscle tone, catalepsy (freezing for a long time in a certain position), negativism (unreasonable refusal, resistance, opposition to any outside influence), mutism (lack of speech with a intact speech apparatus). Cold, uncomfortable posture, wet bed, thirst, hunger, danger (for example, a fire in a hospital) are not reflected in any way on their frozen, amimic face. Patients remain in the same position for a long time; all their muscles are tense. A transition from catatonic stupor to excitation and vice versa is possible. Catatonic excitation. Characterized by an acute onset, suddenness, randomness, lack of focus, impulsiveness of movements and actions, senseless pretentiousness and mannerisms of movements, ridiculous unmotivated exaltation, aggression.

hebephrenic syndrome. Foolish, ridiculous behavior, mannerisms, grimacing, lisping speech, paradoxical emotions, impulsive actions are characteristic. May be accompanied by hallucinatory - paranoid and catatonic syndromes.

The depersonalization-derealization syndrome is characterized by a painful experience of a change in one's own personality and the surrounding world, which cannot be described.

depression in schizophrenia

Depressive symptoms in schizophrenia (both during exacerbation and in remission) are often observed. Depression is one of the most common causes of suicidal behavior in schizophrenic patients. It should be remembered that 50% of patients with schizophrenia commit suicide attempts (15% are fatal). In most cases, depression is due to three causes.

Depressive symptoms can be an integral part of the schizophrenic process (for example, with the predominance of a depressive paranoid syndrome in the clinical picture).

Depression can be caused by awareness of the severity of their disease and the social problems that patients face (narrowing of the circle of communication, misunderstanding on the part of relatives, labeling "psycho", labor maladjustment, etc.). In this case, depression is a normal reaction of a person to a serious illness.

Depression often occurs as a side effect of neuroleptics.

CLASSIFICATION

The division of schizophrenia according to its clinical forms is carried out according to the predominance of one or another syndrome in the clinical picture. Such a division is conditional, because only a small number of patients can be confidently assigned to one type or another. Patients with schizophrenia are characterized by significant changes in the clinical picture during the course of the disease, for example, at the beginning of the disease, the patient has a catatonic form, and after a few years he also has symptoms of the hebephrenic form.

Forms of schizophrenia

. simple form characterized by a predominance of negative symptoms without psychotic episodes. A simple form of schizophrenia begins with the loss of previous motivations for life and interests, idle and meaningless behavior, isolation from real events. It slowly progresses, and the negative manifestations of the disease gradually deepen: decreased activity, emotional flatness, poverty of speech and other means of communication (facial expressions, eye contact, gestures). Efficiency in study and work decreases until their complete cessation. Hallucinations and delusions are absent or occupy a small place in the picture of the disease.

. paranoid form- the most common form; the clinical picture is dominated by hallucinatory-paranoid syndrome and mental automatism syndrome. The paranoid form is characterized by the predominance of delusional and hallucinatory disorders in the picture of the disease, forming paranoid, paranoid syndromes, the Kandinsky-Clerambault mental automatism syndrome and paraphrenic syndrome. At first, a tendency to systematize nonsense is noted, but in the future it becomes more and more fragmentary, absurd and fantastic. As the disease develops, negative symptoms appear and intensify, forming a picture of an emotional-volitional defect.

. hebephrenic form characterized by the predominance of hebephrenic syndrome. This form differs from the simple greater mobility of patients, fussiness with a touch of foolishness and mannerism, instability of mood is characteristic. Patients are verbose, prone to reasoning, stereotyped statements, their thinking is poor and monotonous. Hallucinatory and delusional experiences are fragmentary and startling in their absurdity. According to E. Kraepelin, only 8% of patients have favorable remissions, but in general the course of the disease is malignant.

. Catatonic form is characterized by the predominance of the catatonic syndrome in the clinical picture of the disease. This form manifests itself as a catatonic stupor or excitation. These two states can alternate with each other. Catatonic disorders are usually combined with hallucinatory-delusional syndrome, and in the case of an acute paroxysmal course of the disease - with oneiroid syndrome.

Flow and types of flow

There are continuous and paroxysmal - progredient types of schizophrenia. Before the appearance of the ICD-10 in domestic psychiatry, there were two more types of flow: recurrent and sluggish. The ICD-10 (as well as the DSM-IV) does not include the diagnoses of recurrent schizophrenia and indolent schizophrenia. Currently, these disorders are distinguished as separate nosological units - schizoaffective disorder and schizotypal disorder, respectively (see Schizoaffective disorder, Schizotypal disorder).

The continuous type of course is characterized by the absence of clear remissions during treatment, the steady progression of negative symptoms. Spontaneous (without treatment) remissions are not observed in this type of course. In the future, the severity of productive symptoms decreases, while negative symptoms become more pronounced, and in the absence of the effect of treatment, it comes to the complete disappearance of positive symptoms and pronounced negative symptoms. The continuous type of flow is observed in all forms of schizophrenia, but it is exceptional for simple and hebephrenic forms.

The paroxysmal - progredient type of the course is characterized by complete remissions between attacks of the disease against the background of the progression of negative symptoms. This type of schizophrenia in adulthood is the most common (according to various authors, it is observed in 54-72% of patients). Seizures vary in severity, clinical manifestations and duration. The appearance of delusions and hallucinations is preceded by a period with severe affective disorders - depressive or manic, often replacing each other. Mood swings are reflected in the content of hallucinations and delusions. With each subsequent attack, the intervals between attacks become shorter and the negative symptoms worsen. In the period of incomplete remission, patients remain anxious, suspicious, tend to delusionally interpret any actions of others, hallucinations occasionally occur. Particularly characteristic are persistent subdepressive states with reduced activity, a hypochondriacal orientation of experiences.

Diagnostics

Research methods. There is no effective test to diagnose schizophrenia. All studies are directed mainly to the exclusion of an organic factor that could cause the disorder. Laboratory research methods: .. KLA and OAM .. biochemical blood test .. thyroid function test .. blood test for vitamin B 12 and folic acid .. blood test for the content of heavy metals, drugs, psychoactive drugs, alcohol. Special methods. CT and MRI: rule out intracranial hypertension, brain tumors.. EEG: rule out temporal lobe epilepsy. Psychological methods (personality questionnaires, tests [for example, Rorschach tests, MMPI]).

Differential Diagnosis

Psychotic disorders caused by somatic and neurological diseases. Symptoms similar to those of schizophrenia are observed in many neurological and somatic diseases. Mental disorders in these diseases appear, as a rule, at the onset of the disease and precede the development of other symptoms. Patients with neurological disorders tend to be more critical of their illness and more concerned about the onset of symptoms of mental illness than those with schizophrenia. When examining a patient with psychotic symptoms, an organic etiological factor is always ruled out, especially if the patient has unusual or rare symptoms. The possibility of a superimposed organic disease should always be kept in mind, especially when the schizophrenic patient has been in remission for a long time or when the quality of the symptoms changes.

Simulation. Schizophrenic symptoms can be invented by patients or for the purpose of obtaining a "secondary benefit" (simulation). Schizophrenia can be feigned because the diagnosis is largely based on the statements of the patient. Patients who really suffer from schizophrenia sometimes make false complaints about their alleged symptoms in order to receive some benefits (for example, transfer from the 3rd disability group to the 2nd).

Mood disorder. Psychotic symptoms are observed in both manic and depressive states. If the mood disorder is accompanied by hallucinations and delusions, their development occurs after pathological mood changes occur, and they are not stable.

Schizoaffective disorder. In some patients, the symptoms of a mood disorder and the symptoms of schizophrenia develop simultaneously, are expressed in the same way; therefore, it is extremely difficult to determine which disorder is primary - schizophrenia or a mood disorder. In these cases, a diagnosis of schizoaffective disorder is made.

Chronic delusional disorder. The diagnosis of delusional disorder is justified in case of systematized delusions of non-bizarre content lasting at least 6 months, with the preservation of normal, relatively high functioning of the personality without severe hallucinations, mood disorders and the absence of negative symptoms. The disorder occurs in adulthood and old age.

Personality disorders. Personality disorders can be combined with manifestations characteristic of schizophrenia. Personality disorders - stable features that determine behavior; the time of their onset is more difficult to determine than the onset of schizophrenia. As a rule, psychotic symptoms are absent, and if they are, they are transient and unexpressed.

Reactive psychosis (brief psychotic disorder). Symptoms persist for less than 1 month and occur after a well-defined stressful situation.

Treatment

TREATMENT

Social - psychological support in combination with drug therapy can reduce the frequency of exacerbations by 25-30% compared with the results of treatment with neuroleptics alone. Psychotherapy for schizophrenia is ineffective, so this method of treatment is rarely used.

The patient is explained the nature of the disease, calmed down, discussed with him his problems. The patient is trying to form an adequate attitude to the disease and treatment, the skills of timely recognition of signs of an impending relapse. An excessive emotional reaction of the patient's relatives to his disease leads to frequent stressful situations in the family, provokes an exacerbation of the disease. Therefore, the patient's relatives should be explained the nature of the disease, methods of treatment and side effects (side effects of antipsychotics often frighten relatives).

Basic principles of drug therapy

Drugs, doses, duration of treatment are selected individually, strictly according to the indications, depending on the symptoms, the severity of the disorder and the stage of the disease.

Preference should be given to a drug that has previously been effective in this patient.

Treatment usually begins with the appointment of small doses of drugs, gradually increasing them until the optimal effect is obtained. In case of acute development of an attack with severe psychomotor agitation, the drug is administered parenterally; if necessary, the injections are repeated until the excitation is completely relieved, and in the future, the treatment method is determined by the dynamics of the psychopathological syndrome.

The most common mistake is prescribing more neuroleptics to patients than necessary. Studies have shown that smaller amounts of antipsychotics generally produce the same effect. When the clinic increases the patient's dose of antipsychotic drugs every day, giving the impression that in this way they increase treatment and reduce psychotic symptoms, in fact this effect depends only on the time of exposure to the drug. Long-term administration of neuroleptics in high doses often leads to the development of side effects.

Subjective severe sensations after the first dose of the drug (often associated with side effects) increase the risk of a negative result of treatment and patient avoidance of treatment. In such cases, it is necessary to think about changing the drug.

The duration of treatment is 4-6 weeks, then, if there is no effect, a change in the treatment regimen.

With the onset of incomplete and unstable remission, the doses of drugs are reduced to a level that ensures the maintenance of remission, but does not cause depression of mental activity and pronounced side effects. Such maintenance therapy is prescribed for a long time on an outpatient basis.

Basic drugs

Antipsychotics - chlorpromazine, levomepromazine, clozapine, haloperidol, trifluoperazine, flupentixol, pipothiazine, zuclopenthixol, sulpiride, quetiapine, risperidone, olanzapine.

Antidepressants and tranquilizers are prescribed for depressive and anxiety states, respectively. When a depressive effect is combined with anxiety and restlessness, antidepressants with a sedative effect, such as amitriptyline, are used. For depression with lethargy and decreased energy of behavior, antidepressants are used that have a stimulating effect, such as imipramine, or without a sedative effect, such as fluoxetine, paroxetine, citalopram. Tranquilizers (eg, diazepam,zepine) are used short-term to treat anxiety.

Complications in the treatment of neuroleptics

Long-term therapy with neuroleptics can lead to the development of persistent complications. Therefore, it is important to avoid unnecessary treatment by changing doses depending on the patient's condition. Anticholinergic drugs prescribed for relief of side extrapyramidal symptoms, with long-term constant use, increase the risk of tardive dyskinesia. So anticholinergic drugs are not used constantly and for prophylactic purposes, and are prescribed only in case of side extrapyramidal symptoms.

Akineto - hypertensive syndrome .. Clinical picture: mask-like face, rare blinking, stiffness of movements .. Treatment: trihexyphenidyl, biperiden.

Hyperkinetic - hypertensive syndrome .. Clinical picture: akathisia (restlessness, restlessness in the legs), tasikinesia (restlessness, desire to constantly move, change position), hyperkinesis (choreiform, athetoid, oral) .. Treatment: trihexyphenidyl, biperiden.

Dyskinetic syndrome .. Clinical picture: oral dyskinesias (tension of masticatory, swallowing muscles, muscles of the tongue, an irresistible desire to stick out the tongue), oculogiric crises (painful rolling of the eyes) .. Treatment: trihexyphenidyl (6-12 mg / day), 20% r - r caffeine 2 ml s / c, chlorpromazine 25-50 mg / m.

Chronic dyskinetic syndrome .. Clinical picture: hypokinesia, increased muscle tone, hypomimia in combination with local hyperkinesis (complex oral automatisms, tics), decreased urges and activity, akairiya (annoyance), emotional instability .. Treatment: nootropics (piracetam 1200-2400 mg / day for 2-3 months), multivitamins, tranquilizers.

Malignant neuroleptic syndrome .. Clinical picture: dry skin, acrocyanosis, greasy hyperemic face, forced posture - on the back, oliguria, increased blood clotting time, increased residual nitrogen in the blood, renal failure, decreased blood pressure, increased body temperature .. Treatment : infusion therapy (rheopolyglucin, hemodez, crystalloids), parenteral nutrition (proteins, carbohydrates).

Intoxication delirium develops more often in men over 40 years of age (with a combination of chlorpromazine, haloperidol, amitriptyline. Treatment is detoxification.

Forecast for 20 years: recovery - 25%, improvement - 30%, care and / or hospitalization required - 20%. 50% of patients with schizophrenia commit suicide attempts (15% with a fatal outcome). The older the age of onset, the better the prognosis. The more pronounced the affective component of the disorder, the more acute and shorter the attack, the better it can be treated, the more likely it is to achieve a complete and stable remission.

Synonyms. Bleuler's disease, Dementia praecox, Discordant psychosis, Early dementia

ICD-10 . F20 Schizophrenia

Notes.

Pfropfschizophrenia (from German Pfropfung - vaccination) - schizophrenia developing in an oligophrenic; oligoschizophrenia; pfropfgebephrenia;

Senestic schizophrenia Huber - schizophrenia with a predominance of senestopathies in the form of sensations of burning, constriction, tearing, turning over, etc.

Schizophrenia-like psychosis (pseudo-schizophrenia) is a psychosis that is similar or identical in clinical presentation to schizophrenia.

Schizophrenia-like syndrome is a general name for psychopathological syndromes similar in manifestations to schizophrenia, but occurring in other psychoses.

Nuclear schizophrenia (galloping) is the rapid development of emotional devastation with the disintegration of pre-existing positive symptoms (end state).