Since the time of the teachings of degeneration by B. Morel and later, throughout the 19th and 20th centuries, psychiatrists from different countries have repeatedly expressed the idea that “dementia praecox” and schizophrenia should be considered a hereditary disease.

Frequent cases of schizophrenia in one family were explained by a genetic predisposition to this mental disorder. It was even argued that hereditary burden of schizophrenia confirms its nosological integrity.

At the end of the 30s of the twentieth century, K. Luxenburger (1938) wrote: “Recent years have taught us, in any case, that the clinic and psychopathology unsuccessfully tried to destroy the unity of schizophrenia. It must be considered, first of all, as a hereditary-biological unity.” However, other psychiatrists, in particular H. Kallmann (1938), believed that a “marginal” predisposition with a lower and a “nuclear” predisposition with a greater probability of developing schizophrenia should be distinguished. K. Luxenburger and H. Kallmann cited conflicting data regarding the concordance of schizophrenia in identical twins and spoke differently about the fatal role of the genotype in the genesis of schizophrenia.

Some psychiatrists have noted that in “schizophrenia-like conditions,” the prognosis is clearly more favorable than in “true schizophrenia,” since in the first case there is only a “partial predisposition” in the form of connective tissue weakness or a tendency to contract tuberculosis. In this situation, the attentive reader will notice the influence of E. Kraepelin, who wrote about the outcome of schizophrenia.

According to a number of researchers in the first half of the twentieth century, conditions resembling clinical manifestations of schizophrenia require exogenous activation to a much greater extent than true schizophrenia.

It has been noted that people who are “semi-severe” or “semi-predisposed” to schizophrenia are characterized by character oddities, unusual features personality type. Some of them, perhaps even significant ones, at various moments in life, during any illness or stress, reveal mildly expressed and, as a rule, manifest themselves for a short time psychopathological symptoms(“sounding symptoms”), which were also observed in the clinical picture of schizophrenia.

The similarity of a number of mental disorders in their clinical symptoms to manifestations of schizophrenia led to the idea of ​​the existence of its “atypical forms”. K. Leonhard (1940) spoke about the inheritance of “atypical schizophrenia” in a special way. At the same time, his idea that “atypical forms of schizophrenia” should be distinguished by a greater hereditary burden seemed paradoxical.

In the mid-twentieth century, information appeared that some variants of manic-depressive psychosis (“atypical psychoses”) and schizophrenia may have the same hereditary basis. These assumptions undermined the nosological independence of schizophrenia, but were most often refuted by the results of other studies.

Atypical endogenous psychoses, combining signs of both schizophrenia and manic-depressive psychosis, were described by domestic researchers in the third quarter of the twentieth century under the name “periodic schizophrenia.” At the same time the results genetic research“periodic schizophrenia” was not given the opportunity to recognize it as a separate nosological unit.

If in the first half of the twentieth century most studies on the genetics of schizophrenia were carried out from the perspective of the hereditary homogeneity of the disease, then in the late 60s years, many psychiatrists have criticized this approach (WHO, 1967).

In the middle of the twentieth century, Japanese scientists, using a large amount of factual material, showed that “periodic schizophrenia” is characterized by a specific genotype that is not associated with a predisposition to other mental illnesses.

In the 60s, some researchers believed that the predisposition or “inclination” to schizophrenia is transmitted in the family according to the type of autosomal recessive and intermediate inheritance, i.e. heterozygous carriers of this recessive “inclination”, from the point of view of phenotype, even “outwardly” often differ from persons who are completely free from the hereditary “inclination” (Galachyan A., 1962).

Due to the fact that the division of traits into dominant and recessive is quite artificial, the idea has been rightly expressed that many hereditary diseases, including schizophrenia, are characterized by both dominant and recessive types of inheritance.

The phenomena of incomplete dominance and incomplete recessiveness are known; the same gene, dominant in a heterozygous individual in a homozygous state, has a quantitatively and qualitatively different effect. Examples of codominance indicate that the classification of a phenotype as recessive or dominant is largely determined by the sensitivity of the method for identifying the mechanisms of gene action.

It was assumed that the schizophrenic genotype manifests itself primarily as a disease of the brain, but, according to scientists of those years, it could also be detected in disorders of the functions of other organs. Based on this hypothesis, J. Wyrsch., 1960, and a number of other authors concluded that hopes for quality care for patients with schizophrenia should be placed not on psychopathology, but on pathophysiology.

At one time, a case of schizophrenia in the famous quartet of identical twin girls, described in the monograph by D. Rosenthal et al, aroused great interest among psychiatrists. (1963). The girls' father was noted for his mental instability. All four girls studied normally at school, three of them graduated well, but at the age of 20-23, all girls began to develop manifestations of schizophrenia, and very rapidly with signs of catatonia in the one who did not finish high school.

Many researchers have assumed that in schizophrenia, the weakness of certain systems and, in particular, the way their physiological reactions to internal and external factors(Semyonov S.F., 1962). Some scientists have argued that genetic disorders in various mental disorders may be identical.

The genetic spectrum group of schizophrenia usually included: latent schizophrenia, schizotypal disorder, schizoid and paranoid personality disorder.

In Russian psychiatry, V.P. wrote about the genetic heterogeneity of schizophrenia. Efroimson and M.E. Vartanyan (1967).

Most researchers came to the conclusion that there is no reason to assume a genetic connection between manic-depressive psychosis, “periodic schizophrenia,” atypical endogenous psychoses and “true” procedural schizophrenia (Kunin A.Sh., 1970).

In the 70s of the twentieth century, the idea that schizophrenia included various diseases was confirmed by facts discovering genetic differences between paranoid schizophrenia and hebephrenia(Vinocur J., 1975).

For modern researchers of the genetics of schizophrenia, this area is of interest in three aspects: genetics can reveal the etiology of schizophrenia; The pharmacogenetic approach allows you to optimize the therapeutic process, individually select drugs for its treatment and minimize side effects drug therapy; The genetic research method allows us to answer the question about the polymorphism of the clinical picture of schizophrenia (Sullivan P. Et al., 2006).

Main directions of genetic research of schizophrenia

• Studying the etiology of schizophrenia
• Study of the genesis of clinical polymorphism of schizophrenia
• Pharmacogenetic studies

Relatives of patients with schizophrenia

Modern geneticssuggests that even general aspects of an adult’s personality are genetically determined, for example, an increased level of anxiety, manifested, in particular, by worry about one’s health and excessive worry when it is necessary to make a decision in difficult situations.

Anxiety or calmness, shyness or insolence, the strength of instincts, necessity and exactingness in satisfying them, alertness, sensitivity to criticism, the degree of disorganization of behavior in difficult circumstances, according to some geneticists, are also hereditarily determined. As evidence of this point of view, information is provided about identical twins who grew up in different conditions, but were similar to each other in the above and other personal characteristics.

Recently, evidence has emerged that even the search for adventure and love of risk are partially associated with alleles at the locus of a certain gene (Victor M., Ropper A., ​​2006).

Mental disorders in the genesis of which the hereditary factor plays a particularly important role

• Hyperactivity
• Schizophrenia
• Affective disorders

At one time, employees of the pathophysiological laboratory of the Institute of Psychiatry of the USSR Academy of Medical Sciences demonstrated that a number of biochemical and immunological abnormalities found in patients with schizophrenia can also be identified in their relatives. We were talking, in particular, about such deviations as the ratio of lactate and pyruvate in the blood, the presence of altered forms of lymphocytes, distortion of immune reactions, etc. (Vartanyan M.E., 1972).

At the same time, studies have shown that the range of personality anomalies among first-degree relatives is limited and is usually limited to schizoid disorders (Shakhmatova-Pavlova I.V., 1975).

It was proposed to distinguish three main categories of relatives of patients with schizophrenia:

• persons with strictly schizoid features, with a “vital tone”, a background independent of the external environment, which determined the pace and intensity mental activity;
• persons with schizoid features and a predominance of a pronounced emotional defect;
• schizoid individuals with distinct affective disorders (increased mood levels, bipolar phase changes, seasonal depression).

Approximately 20-30% of first-degree relatives of patients with schizophrenia have so-called “spectrum disorders,” which are more or less weakened symptoms of schizophrenia. These “weakened symptoms” most often appear in the form of a sharpening of certain personality traits: isolation, increased vulnerability, “emotional dullness.”

Japanese scientists, when studying cases of schizophrenia in childhood, found a high frequency of schizoid psychopathy among parents of children.

Variants of schizoid personalities among relatives of patients with schizophrenia

1. Individuals with an altered “vital tone” (“a background of mental activity independent of the external environment”)
2. Individuals with signs of “emotional defect” (“emotional dullness”)
3. Closed, sensitive personalities

According to I.V. Shakhmatova-Pavlova (1975) there is a schizophrenic continuum in the family, represented by a number of disorders (pronounced psychosis, erased forms, character anomalies, accentuated personality), and this continuum is in good agreement with the theory of the influence of a combination of factors on the pathogenesis of schizophrenia (Morkovkin V.M. , Kartelishev A.V., 1988).

Some studies have found that relatives of patients with schizotypal traits and a diagnosis of schizotypal personality disorder have lower scores on some cognitive tests than relatives without personality abnormalities (Cannon., 1994).

Features of the cognitive sphere of relatives of patients with schizophrenia

• Altered speed of psychomotor reactions
• Impaired short-term verbal and visual memory
• Attention instability
• Features of abstract thinking (unusuality of concept formation, information coding)
• Difficulties in creating an action plan and consistently implementing goals
• Difficulties in copying images

Modern studies of the cognitive sphere of relatives of patients with schizophrenia make it possible to substantiate the position of the presence of independent cognitive syndromes in patients and in persons with a high genetic risk of schizophrenia. These syndromes are associated with genes involved in the formation of different biochemical systems. It is assumed that the preservation of cognitive processes in some relatives of patients is explained by the successful compensation of primary disorders due to sufficient intellectual resources (Alfimova M.V., 2007).

C. Gilvarry et al. (2001) showed that in relatives of patients with schizophrenia, the severity of paranoid traits correlates with IQ, schizoid traits with the speed of psychomotor reactions, and schizotypal traits with verbal fluency.

>Patients with schizophrenia and their relatives often exhibit similar features of cognitive processes.

Analysis of schizotypal traits leads to the idea that disorganization of thinking and speech is associated with stability of attention and the state of psychomotor functions, and disruption of interpersonal relationships is associated with stability of attention and characteristics of short-term verbal memory (Squires-Wheeler E., et al., 1997; Chen W. , et al., 1998). At the same time, the connection between schizotypal traits and cognitive impairment is detected in relatives of patients, but not in individuals without a hereditary history of schizophrenia. Due to the above, it can be assumed that neurocognitive deficit reflects a hereditary predisposition to schizophrenia (Alfimova M.V., 2007). According to R. Asarnow et.al. (2002). Moreover, neurocognitive deficits can be transmitted as an inherited trait in families of patients, regardless of the presence of schizophrenia spectrum disorders.

Schizophrenia researchers have repeatedly tried to find signs that reflect the influence of the genotype that predisposes to schizophrenia (“endophenotype”).

The term “endophenotype” in relation to schizophrenia was proposed by I. Gottesman and J. Schields (1972), who understood “endophenotype” as an internal phenotype or trait that is intermediate between the clinical manifestations and the genotype of schizophrenia. In their later works, these authors identified a number of criteria according to which a trait could be considered an “endophenotype”: the trait is associated with a disease at the population level, is an inherited trait, its severity is practically independent of the condition or severity of the disease, within families, endophenotype and disease cosegregate, the endophenotype is detected more often in unaffected relatives of the patient than in the general population. According to I. Gottesman and J. Schields (2003), other terms, for example, such as “intermediate phenotype”, “biological marker”, “susceptibility marker”, should be used to refer to those traits that do not necessarily reflect the genetic characteristics of the disease, or may be a manifestation of other factors influencing the occurrence and course of schizophrenia.

W. Kremen et al. (1994) concluded that people genetically predisposed to schizophrenia demonstrate the most pronounced cognitive impairment. First of all, we are talking about stability of attention, perceptual-motor speed, concept formation, features of abstract thinking, context processing, control over mental processes and coding. In addition, a number of researchers have identified disturbances in visual and verbal associative memory in relatives of patients with schizophrenia (Trubnikov V.I., 1994).

M. Appels (2002) found cognitive changes in parents of patients with schizophrenia, similar to changes in the patients themselves, but expressed to a weaker degree.

M. Sitskoorn et al. (2004) based on the results of a meta-analysis showed that for integral indicators of the reproduction of verbal information and executive functions, the effect size (the degree of difference of the average value of the trait in a group of relatives of patients with schizophrenia from normative indicators - d) is quite pronounced (d = 0.51), and for attention indicators is uninformative (d = 0.28).

Among the memory subprocesses, the maximum differences between the relatives of patients and the control group were found when analyzing the results of immediate reproduction of a list of words (d = 0.65), immediate and delayed text reproduction (d = 0.53 and 0.52), the minimum - for delayed reproduction visual information (0.32) (Whyte M. Et al., 2005).

The results of another meta-analysis showed that in relatives of patients with schizophrenia, the most informative tests were tests of semantic verbal fluency, as well as tests of copying figures according to a pattern and learning a list of words. Researchers noted that the severity of these disorders in relatives of patients with schizophrenia is influenced by age and education and is not influenced by personality type and degree of relationship (Snitz B. et al., 2006). These studies also looked at the prevalence of cognitive impairment. It turned out that relatives of patients with schizophrenia in approximately 70% of cases exhibit mild cognitive impairment, reminiscent of cognitive disorders in patients with schizophrenia. The groups of relatives and controls overlapped by 70%, while the groups of patients and controls overlapped by only 45%.

At the same time, it should be noted that the cognitive impairments found in relatives of patients with schizophrenia are only relatively specific to this mental disorder. They are also registered among relatives of patients with affective disorders, which to some extent may indicate the presence of a common, although weakly expressed, genetic predisposition to these mental disorders.

Cognitive disorders in a significant proportion of patients' relatives are most clearly manifested in impairment of executive functions, requiring deep semantic processing of information, and reproduction of verbal information, associated with a heavy load on memory. These disorders have varying degrees of specificity, genetic determination and are differently associated with schizotypal personality traits (Alfimova M.V., 2007).

It is interesting to note that studies of a number of mathematically gifted children have revealed characteristics of the cognitive process that are found in patients with schizophrenia. Indeed, according to the statements of many teachers, children who are inclined towards mathematics are distinguished by strange behavior, originality of views and isolation.

According to our data, relatives of patients have a tendency to develop delusions, there is a special viscosity of thinking, a tendency to excessive detail, and a desire to attribute the actions of people around them to their own account. It is no coincidence that with delusions, unlike hallucinations, it is not possible to find sufficiently distinct changes in certain brain structures. Probably in schizophrenia under the influence pathological process the already existing tendency to form delusions (the tendency to easily generate overvalued ideas) develops into real delusion.

Symptoms of the prodromal period of schizophrenia can be quite difficult to distinguish from the personality characteristics of relatives of patients with schizophrenia. It can be assumed that if there is a genetic predisposition to schizophrenia, which usually manifests itself at the level of phenotype, then under the influence of a number of factors (changes in the activity of the endocrine glands, prolonged traumatic experiences, autoimmune processes, etc.) the disease can clearly manifest itself. At the same time, it can be assumed that the prodromal period of schizophrenia will not necessarily end with the manifestation of diseases, and in this case it is weak pronounced changes personality, mildly expressed neurophysiological and psychophysiological deviations will remain only in the form of a “trace” of the outbreak of the pathological process. This is partly noticeable in the example of the so-called “acquired schizoidization” of the individual.

Morphological changes in the brain of patients with schizophrenia, in particular the expansion of the lateral ventricles, in some cases are similar structural changes brains of patients' relatives. Danish scientists have shown that healthy relatives of patients with schizophrenia often have not only enlarged lateral ventricles, but also an increase in the third ventricle of the brain, a decrease in the size of the thalamus, and a decrease in the volume of the frontal and parietal lobes. Due to the above, anatomical changes in certain brain structures can be considered a genetic risk factor.

Structural and functional changes in the brain, most often recorded in relatives of patients with schizophrenia

• Expansion of the lateral and third ventricles of the brain
• Reduction in the size of the thalamus
• Reduction in the volume of the frontal and parietal lobes
• Dysfunction of eye muscles (anti-saccade test)
• Changes bioelectrical activity basal areas of the frontal and left temporal lobes
• Prepulse inhibition deficit reflecting GABA system deficiency

As is known, the test for atysaccades (eye movement following a tracking object from the periphery of the visual field to the center), which concerns impaired motility of the eye muscles, is considered a fairly specific phenomenon for schizophrenia, reflecting a hereditary predisposition to this disease. Mild abnormalities of pursuit eye movements and mild deviations from the norm in neurophysiological and psychophysiological parameters are often observed in relatives of patients with schizophrenia.

It is interesting to note that foreign researchers, using electrodes implanted for several months, determined that in the basal areas of the frontal lobe of the brain, patients and their relatives exhibit equally deviating curves from the norm.

EEG studies have shown a high probability of inheritance of basic rhythms, especially in the slow-wave part of the spectrum with a relative maximum in the occipital, left middle-temporal, and right central leads.

An electrophysiological study of the bioelectrical activity of the brain revealed patterns characteristic of schizophrenia with high heritability of the main rhythms alpha, beta 1, beta 2, mainly in the leads of the left hemisphere (heritability 42-85%), and slow rhythms, predominantly theta waves, in the left parietal, central and superior frontal leads (52-72%) (Kudlaev M.V., Kudlaev S.V.).

According to V.P. Efroimson and L.G. Kalmykova (1970), the risk of schizophrenia for the general population is approximately 0.85%, for siblings of the patient - 10%, for half-siblings - 3.5%, for children - 14%, for parents - 6%. At the same time, in a marriage between two patients with schizophrenia, the risk of morbidity for children varies widely from 38 to 68%, and the risk for the patient’s siblings increases sharply if one, or even more so two parents suffer from schizophrenia

According to N.S. Natalevich (1970), if a mother suffers from schizophrenia, then the probability of developing this disease in her child is 13.3%, if the father is only 5%.

Research by L. Gottesman (2000) (Table 5) showed that the risk of developing schizophrenia increases from approximately 1% in the general population to 50% in the offspring of two parents with schizophrenia (a similar figure for identical twins with schizophrenia).

According to L. Erlimeyer-Kimling (1968), in a family where there is one parent with schizophrenia, the probability of children becoming ill is 12-16%, and in case of illness of both parents no more 30-46%.

According to V.A. Milev and V.D. Moskalenko (1988) the frequency of schizophrenia for full siblings of probands approaches 16%, while for half siblings it is 6%. Researchers provide data that children of a mother with schizophrenia almost always exhibit certain disorders of social adaptation and develop schizophrenia in more than 40% of cases (Heston L., 1966) or 5 times more often than children of a father with schizophrenia (Ozerova N .I. et al., 1983).

Table 6. Risk of schizophrenia for relatives of patients

Of interest is the comparative percentage of concordance of mental disorders in twin pairs. For monozygotic twins with obsessive-compulsive disorder it reaches 87%, with bipolar affective disorder - 79%, with schizophrenia and alcoholism - 59%. For heterozygous twins with obsessive-compulsive disorder it is 47%, with bipolar affective disorder - 19%, with schizophrenia - 15%, with alcoholism - 36% (Table 7) (Muller N., 2001).

Table 7. Concordance of mental disorders in twins (adapted from Muller N., 2001)

Many researchers have emphasized that heredity is reflected in the type.

In the “parents-children” group, the prevalence of continuous flow was established. Typically, the differences were manifested in the earlier onset of the disease and its severity as it progressed. In 80% of cases, similar clinical attacks of diseases were revealed.

Many authors drew attention to the high concordance of premorbid personality characteristics and a certain relationship between these characteristics and the course of schizophrenia, which was equally noted in identical and fraternal twins. The similarity of reactions to medicinal substances and the results of therapy was also revealed (pharmacogenetics) Lifshits E.Ya., 1970).

Russian Academy of Medical Sciences

RESEARCH CENTER FOR MENTAL HEALTH

SCHIZOPHRENIA

AND ENDOGENOUS DISEASES SCHIZOPHRENIC SPECTRUM

(information for patients and their families)

MOSCOW

Oleychik I.V. - Candidate of Medical Sciences, Head of the Scientific Information Department of the National Center for Mental Health of the Russian Academy of Medical Sciences, Senior Researcher of the Department for the Study of Endogenous Mental Disorders and Affective States

2005, Oleychik I.V.

2005, Scientific Center for Public Health of the Russian Academy of Medical Sciences

PREFACE

With all the vastness of the lexical framework of special psychiatric terminology, the concept of “endogenous diseases of the schizophrenia spectrum” rightfully occupies one of the leading places. And this comes as no surprise either to specialists or to the general public. This mysterious and frightening phrase has long been transformed in our minds into a symbol of the mental suffering of the patient himself, the grief and despair of his loved ones, and the morbid curiosity of ordinary people. In their understanding mental illness most often associated with this concept. At the same time, from the point of view of professionals, this does not fully correspond to the actual situation, since it is well known that the prevalence of endogenous diseases of the schizophrenia spectrum from ancient times to the present day in various regions of the world remains at approximately the same level and on average reaches no more than 1%. However, it is not without reason to believe that the true incidence of schizophrenia significantly exceeds this figure due to more frequent, not taken into account official statistics easily occurring, erased (subclinical) forms of this disease, which, as a rule, do not come to the attention of psychiatrists.

Unfortunately, even today, general practitioners are not always able to recognize the true nature of many symptoms that are closely related to mental ill-being. People who do not have a medical education are especially unable to suspect mild forms of endogenous diseases of the schizophrenia spectrum in the primary manifestations. At the same time, it is no secret that early initiation of qualified treatment is the key to its success. This is an axiom in medicine in general and in psychiatry in particular. The timely start of qualified treatment in childhood and adolescence is especially important, since, unlike adults, children themselves cannot recognize the presence of any illness and ask for help. Many mental disorders in adults are often a consequence of the fact that they were not treated promptly in childhood.

Having communicated for quite a long time with a large number of people suffering from endogenous diseases of the schizophrenia spectrum and with their immediate environment, I became convinced of how difficult it is for relatives not only to properly build relationships with such patients, but also to rationally organize their treatment and rest at home, to ensure optimal social functioning. Relatives of patients have absolutely nowhere to get the necessary information, since there is practically no popular domestic literature devoted to these issues on the shelves of our stores, and foreign publications do not always adequately perform this task due to differences in mentality, legal norms, historically established ideas about mental illnesses in general and diseases schizophrenia spectrum, in particular. Most books on psychiatry are addressed only to specialists who have the necessary knowledge. They are written in complex language, with many special terms that are incomprehensible to people who are far from the problems of medicine.

Based on the foregoing, the author of the work brought to your attention is an experienced specialist in the field of endogenous mental disorders that develop in adolescence - and wrote a book that aims to fill the existing gaps, giving a wide readership an idea of ​​the essence of schizophrenia spectrum diseases, and thereby change the position of society towards patients suffering from them.

The main task of the author is to help you and your loved one survive in case of illness, not break down, and return to full life. By following the advice of a medical practitioner, you can preserve your own mental health and get rid of constant worry about the fate of your loved one. The main signs of an incipient or already developed endogenous disease of the schizophrenia spectrum are described in such detail in the book so that, having discovered disorders of your own psyche or the health of your loved ones similar to those described in this monograph, you have the opportunity to promptly contact a psychiatrist who will determine whether you really or Your relative is sick, or your fears are unfounded.

The book runs through the idea that one should not be afraid of psychiatrists who act primarily in the interests of patients and always meet them halfway. This is all the more important because with such a complex and ambiguous pathology as endogenous diseases of the schizophrenia spectrum, only a doctor can correctly qualify the patient’s condition.

For relatives whose loved ones suffer from mental disorders, information about the initial manifestations of various forms of schizophrenia may be useful. or about clinical variants of the advanced stages of the disease, as well as knowledge about some rules of behavior and communication with a sick person. One of the important recommendations arising from this work is the author’s advice to never self-medicate and not hope that mental disorders will go away on their own. This misconception most often leads to the emergence of protracted forms of the disease that are resistant to any treatment.

The book brought to your attention is presented in a form understandable to every reader, since it is written in simple and intelligible language, and special terms are used in it only if it is impossible to do without them, while all of them have detailed interpretation. When reading the book, one constantly feels the author’s interest in presenting quite complex issues in a clear and understandable manner for non-specialists. The book will certainly be useful both to the patients themselves and to their immediate circle.

One of the advantages of the monograph is that it destroys the widespread misconception in society about the mentally ill and the fatality of the outcomes of schizophrenia. After all, we all know well that quite a lot of talented people have suffered and are suffering from mental disorders, but their creative successes seem to tell us that the outcome of the disease is not hopeless, that you can and should fight for the health and happiness of your loved ones and, at the same time, win.

In conclusion, we would like to thank the authors of the book “Schizophrenia” sent to us at one time: A. Weizman, M. Poyarovsky, V. Tal, who made us think about the need to create a special monograph for the Russian-speaking reader, which would cover a number of topical issues in a popular form, concerning endogenous diseases of the schizophrenia spectrum.

Chief Researcher

Department for the Study of Endogenous

mental disorders and affective

states of the Scientific Center for Health Protection of the Russian Academy of Medical Sciences,
Doctor of Medical Sciences,

Professor M.Ya. Tsutsulkovskaya

INTRODUCTION

Most people have not only heard, but often used the concept of “schizophrenia” in everyday speech, however, not everyone knows what kind of disease is hidden behind this medical term. The veil of mystery that has accompanied this disease for hundreds of years has not yet been dispelled. Part of human culture is directly in contact with the phenomenon of schizophrenia, and in a broad medical interpretation - endogenous diseases of the schizophrenic spectrum. It is no secret that among those falling under the diagnostic criteria of this group of diseases there is a fairly high percentage of talented, extraordinary people, sometimes achieving serious success in various creative fields, art or science (W. Van Gogh, F. Kafka, V. Nijinsky, M. Vrubel, V. Garshin, D. Kharms, A. Artaud, etc.).

Despite the fact that a more or less coherent concept of endogenous diseases of the schizophrenia spectrum was formulated at the turn of the 19th and 20th centuries, there are still many unclear issues in the picture of these diseases that require careful further study.

Endogenous diseases of the schizophrenia spectrum today represent one of the main problems in psychiatry, which is due to both their high prevalence among the population and significant economic damage associated with social and labor maladaptation and disability of some of these patients.

PREVALENCE OF ENDOGENOUS DISEASES SCHIZOPHRENIC SPECTRUM

According to the International Association of Psychiatrists, about 500 million people worldwide are affected by mental disorders. Of these, at least 60 million suffer from endogenous diseases of the schizophrenia spectrum. Their prevalence in various countries and regions is always approximately the same and reaches 1% with certain fluctuations in one direction or another. This means that out of every hundred people, one is either already sick or will get sick in the future.

Endogenous diseases of the schizophrenia spectrum usually begin at a young age, but can sometimes develop in childhood. The peak incidence occurs in adolescence and adolescence(period from 15 to 25 years). Men and women are affected to the same extent, although men tend to develop signs of the disease several years earlier. In women, the course of the disease is usually milder, with a predominance of mood disorders; the disease affects them to a lesser extent. family life and professional activities. In men, developed and persistent delusional disorders are more often observed; there are frequent cases of a combination of endogenous disease with alcoholism, polysubstance abuse, and antisocial behavior.

DISCOVERY OF ENDOGENOUS DISEASES SCHIZOPHRENIC SPECTRUM

It is probably not a great exaggeration to say that the majority of the population considers schizophrenic diseases to be no less dangerous than cancer or AIDS. In reality, the picture looks different: life confronts us with very wide range clinical options of these many-sided diseases, ranging from the rarest severe forms, when the disease progresses rapidly and leads to disability over several years, to the relatively favorable, paroxysmal variants of the disease that prevail in the population and mild, outpatient cases, when a layman would not even suspect the disease.

The clinical picture of this “new” disease was first described German psychiatrist Emil Kraepelin in 1889 and called it “dementia praecox.” The author observed cases of the disease only in a psychiatric hospital and therefore dealt primarily with the most severely ill patients, which was reflected in the picture of the disease he described. Later, in 1911, the Swiss researcher Eugen Bleuler, who worked for many years in an outpatient clinic, proved that we should talk about the “group of schizophrenic psychoses”, since milder, more favorable forms of the disease that do not lead to dementia often occur here. Refusing the name of the disease originally proposed by E. Kraepelin, he introduced his own term - schizophrenia. E. Bleuler's research was so comprehensive and revolutionary that to this day the international classification of diseases (ICD-10) still retains the 4 subgroups of schizophrenia he identified (paranoid, hebephrenic, catatonic and simple), and the disease itself for a long time bore a second name - "Bleuler's disease".

WHAT ARE SCHIZOPHRENIC SPECTRUM DISEASES?

Currently, endogenous diseases of the schizophrenia spectrum are understood as mental illnesses characterized by disharmony and loss of unity of mental functions (thinking, emotions, movement), a long continuous or paroxysmal course and the presence in the clinical picture of so-called productive symptoms of varying severity (delusions, hallucinations, disorders mood, catatonia, etc.), as well as so-called negative symptoms - personality changes in the form of autism (loss of contact with the surrounding reality), decreased energy potential, emotional impoverishment, increased passivity, the appearance of previously unusual traits (irritability, rudeness, quarrelsomeness etc.).

The name of the disease comes from the Greek words “schizo” - I split, split and “phre n” - soul, mind. With this disease, mental functions seem to be split - memory and previously acquired knowledge are preserved, but other mental activities are disrupted. By splitting we do not mean a split personality, as is often not entirely correctly understood, but a disorganization of mental functions, a lack of their harmony, which often manifests itself in the illogicality of the actions of patients from the point of view of the people around them. It is the splitting of mental functions that determines both the uniqueness of the clinical picture of the disease and the peculiarities of behavioral disturbances in patients, which are often paradoxically combined with the preservation of intelligence. The term “endogenous diseases of the schizophrenia spectrum” in its broadest sense means the loss of the patient’s connection with the surrounding reality, the discrepancy between the remaining capabilities of the individual and their implementation, and the ability for normal behavioral reactions along with pathological ones.

The complexity and versatility of the manifestations of diseases of the schizophrenia spectrum are the reason that psychiatrists in different countries still do not have a common position regarding the diagnosis of these disorders. In some countries, only the most unfavorable forms of the disease are classified as schizophrenia proper, in others - all disorders of the “schizophrenia spectrum”, in others - these conditions are generally denied as a disease. In Russia, in recent years, the situation has changed towards a more strict attitude towards the diagnosis of these diseases, which is largely due to the introduction of the International Classification of Diseases (ICD-10), which has been used in our country since 1998. From the point of view of domestic psychiatrists, schizophrenia spectrum disorders are quite are reasonably considered disease, but only from a clinical, medical point of view. At the same time, in the social sense, it would be incorrect to call a person suffering from such disorders sick, that is, inferior. Despite the fact that the manifestations of the disease can also be chronic, the forms of its course are extremely diverse: from single-attack, when the patient suffers only one attack in his life, to continuous. Often, a person who is currently in remission, that is, outside of an attack (psychosis), can be quite capable and even more productive professionally than the people around him who are healthy in the generally accepted sense of the word.

MAIN SYMPTOMS OF ENDOGENOUS DISEASES OF THE SCHIZOPHRENIC SPECTRUM

(positive and negative disorders)

Endogenous diseases of the schizophrenia spectrum have various options course and, accordingly, are distinguished by a variety of clinical forms. The main manifestation of the disease in most cases is a psychotic state (psychosis). Psychoses are understood as the most vivid and severe manifestations diseases in which the patient’s mental activity does not correspond to the surrounding reality. At the same time, the reflection of the real world in the patient’s mind is sharply distorted, which manifests itself in behavioral disturbances, the ability to correctly perceive reality and give the correct explanation of what is happening. The main manifestations of psychosis in general and in diseases of the schizophrenia spectrum in particular are: hallucinations, delusions, thinking and mood disorders, motor (including so-called catatonic) disorders.

Ghallucinations (deceptions of perception) are one of the most common symptoms of psychosis in diseases of the schizophrenia spectrum and represent disturbances in the sensory perception of the environment - the sensation exists without a real stimulus that causes it. Depending on the senses involved, hallucinations may be auditory, visual, olfactory, gustatory, or tactile. In addition, they can be simple (bells, noise, calls) and complex (speech, various scenes). The most common hallucinations are auditory. People suffering from this disorder may occasionally or constantly hear so-called “voices” inside the head, their own body, or coming from outside. In most cases, “voices” are perceived so vividly that the patient does not have the slightest doubt about their reality. A number of patients are completely convinced that these “voices” are transmitted to them in one way or another: using a sensor implanted in the brain, a microchip, hypnosis, telepathy, etc. For some patients, “voices” cause severe suffering; they can command the patient, comment on his every action, scold, and mock. Imperative (commanding) “voices” are rightfully considered the most unfavorable, since patients, obeying their instructions, can commit acts that are dangerous to themselves and others. Sometimes patients mechanically obey the “voices,” sometimes they answer or argue with them, and occasionally they freeze silently, as if listening. In a number of cases, the content of the “voices” (the so-called “inner world of illness”) becomes much more important for the patient than the external, real world, which leads to detachment and indifference to the latter.

Signs of auditory and visual hallucinations:

Self-talk that resembles a conversation or remarks in response to someone's questions.

Sudden silence, as if a person is listening to something.

Unexpected causeless laughter.

Alarmed, preoccupied look.

Inability to focus on a topic of conversation or a specific task.

The impression that your relative hears or sees something that you do not perceive.

How to respond to the behavior of a person suffering from hallucinations:

It is gentle to ask if he is hearing anything now and what exactly.

Discuss how to help him cope at the moment with these experiences or with what causes them.

Help you feel more secure.

Carefully express the opinion that what is perceived may be just a symptom of a disease, an apparent phenomenon, and therefore it is worth seeking help from a doctor.

You should not:

Taunt the patient or ridicule his feelings.

Be afraid of his experiences.

Convince the patient of the unreality or insignificance of what he perceives.

Engage in a detailed discussion of hallucinations.

Delusional ideas- these are persistent beliefs or conclusions, not corresponding to reality, completely mastering the consciousness of the patient, arising on a painful basis, not amenable to correction, the influence of reasonable arguments or evidence, and not being an instilled opinion that can be acquired by a person as a result of appropriate upbringing, education received, the influence of traditions and cultural environment.

A delusional idea arises as a result of a misinterpretation of the surrounding reality generated by the disease and, as a rule, has nothing to do with reality. Therefore, attempts to convince the patient end up strengthening him even more in his painful concept. The content of delusional ideas can be very diverse, but most often delusions of persecution and influence are observed (patients believe that they are being spied on, they want to kill them, intrigues are woven around them, conspiracies are organized, they are influenced by psychics, aliens, otherworldly forces or special services using X-rays and laser beams, radiation, “black” energy, witchcraft, damage, etc.). In all their problems, such patients see the machinations of someone, most often close people, neighbors, and they perceive every external event as relating to them personally. Often, patients claim that their thoughts or feelings arise under the influence of some supernatural forces, are controlled from the outside, stolen or broadcast publicly. The patient can complain to various authorities about intruders, contact the police, move from apartment to apartment, from city to city to no avail, but even in a new place the “persecution” soon resumes. Delusions of invention, greatness, reformation, and special treatment are also very common (the patient thinks that everyone around him is mocking him or condemning him). Quite often, hypochondriacal delusions occur, in which the patient is convinced that he is suffering from some terrible and incurable disease, persistently proves that his internal organs are damaged, and requires surgical intervention. Delusions of damage are especially typical for older people (a person constantly lives with the thought that in his absence his neighbors are spoiling things that belong to him, adding poison to his food, stealing, or trying to escape from the apartment).

Delusional ideas are easily recognized even by ignorant people if they are fantastic or clearly ridiculous in nature. For example, a patient states that he recently returned from an intergalactic trip, was implanted into the body of an earthling for experimental purposes, continues to maintain contact with his home planet, and will soon have to go to the Amazon, where the starship that has arrived for him will land. The behavior of such a patient also changes sharply: he treats loved ones as if they were strangers, communicates with them only in private, while in the hospital, refuses to accept help from them, and becomes arrogant with everyone around him.

It is much more difficult to recognize a delusional plot if it is very plausible (for example, the patient claims that his former business partners want to settle scores with him, for which they installed listening devices in the apartment, they are watching him, taking photographs, etc. or the patient expresses a persistent conviction in adultery, as evidenced by numerous everyday “evidence”). In such cases, others for a long time may not even suspect that these people have a mental disorder. Particularly dangerous are delusional ideas of self-blame and sinfulness that arise during depressive-delusional attacks of schizophrenia. It is in this state that extended suicides are often committed, when the patient first (out of good intentions, “so as not to suffer”) kills his entire family, including young children, and then commits suicide.

The appearance of delirium can be recognized by the following signs:

Changed behavior towards relatives and friends, manifestation of unreasonable hostility or secrecy.

Direct statements of implausible or questionable content (for example, about persecution, about one's own greatness, about one's guilt.)

Expressing fears for one’s life and well-being, as well as the life and health of loved ones without obvious grounds.

A clear manifestation of fear, anxiety, protective actions in the form of curtaining windows, locking doors.

Individual, meaningful statements that are incomprehensible to others, adding mystery and significance to everyday topics.

Refusal to eat or checking food carefully.

Active actions of a litigious nature devoid of a real reason (for example, statements to the police, complaints to various authorities about neighbors, etc.).

How to respond to the behavior of a person suffering from delusions

Do not ask questions that clarify the details of delusional statements and statements.

Do not argue with the patient, do not try to prove that his beliefs are wrong. Not only does this not work, but it can also worsen existing disorders.

If the patient is relatively calm and inclined to communicate and help, listen carefully, reassure him and try to convince him to see a doctor.

If delirium is accompanied by strong emotions (fear, anger, anxiety, sadness), try to calm the patient and contact a qualified doctor as soon as possible.

Mood disorders* (affective disorders) with endogenous diseases of the schizophrenia spectrum are manifested by depressive and manic states.

Depression (lat. depression - oppression, suppression) is a mental disorder characterized primarily by pathologically low mood, melancholy, depression, motor and intellectual retardation, disappearance of interests, desires, drives and impulses, decreased energy, a pessimistic assessment of the past, present and future, ideas of low value, self-blame , thoughts about suicide. Depression is almost always accompanied by somatic disorders: sweating, rapid heartbeat, decreased appetite, decreased body weight, insomnia with difficulty falling asleep or painful early awakenings, cessation of menstruation (in women). As a result of depressive disorders, ability to work sharply decreases, memory and intelligence deteriorate, the range of ideas is impoverished, self-confidence and the ability to make decisions disappear. As a rule, patients feel especially bad in the morning; in the afternoon, symptoms may subside, only to return the next morning with renewed vigor. Severity depression can vary from psychologically understandable sadness to boundless despair, from a slight decrease in activity to the appearance of stupor (extreme lethargy, even immobility).

Mania (Greek) mania- passion, madness, attraction ), on the contrary, is a combination of unreasonably elevated mood, acceleration of the pace of thinking and motor activity. The intensity of the above symptoms varies widely. The mildest cases are called hypomania. In the perception of many others, people suffering from hypomania are very active, cheerful, enterprising, although somewhat cheeky, unnecessary and boastful people. The painful nature of all these manifestations becomes obvious when hypomania changes to depression or when the symptoms of mania deepen. In a distinct manic state, an excessively elevated mood is combined with an overestimation of the capabilities of one’s own personality, the construction of unrealistic, sometimes fantastic plans and projections, the disappearance of the need for sleep, the disinhibition of drives, which manifests itself in alcohol abuse, drug use, and promiscuity. As a rule, with the development of mania, the understanding of the painfulness of their condition is very quickly lost, patients commit rash, absurd actions, quit work, disappear from home for a long time, squander money, give things away, etc.

It should be noted that depression and mania can be simple or complex. The latter include a number of additional symptoms. Diseases of the schizophrenia spectrum are most often characterized by complex affective symptom complexes, including, in addition to depressed mood, hallucinatory experiences, delusional ideas, various thinking disorders, and in severe forms, catatonic symptoms.

Movement disorders (or, as they are also called, “catatonic”) are a symptom complex mental disorders, manifested either in the form of stupor (immobility) or in the form of excitement. With catatonic stupor, increased muscle tone is noted, often accompanied by the patient’s ability to maintain a forced position (“waxy flexibility”) for a long time. When stupor occurs, the patient freezes in one position, becomes inactive, stops answering questions, looks in one direction for a long time, and refuses to eat. In addition, passive submission is often observed: the patient has no resistance to changing the position of his limbs and posture. In some cases, the opposite disorder may be observed - negativism, which is manifested by the patient’s unmotivated, senseless opposition to the words and especially the actions of the person entering into communication with him. In a broad sense, negativism is a negative attitude towards the influences of the external environment, fencing off from external impressions and counteracting stimuli coming from outside. Speech negativism manifests itself mutism(from the Latin “mutus” - mute), which is understood as a violation of the volitional sphere, manifested in the patient’s absence of responsive and voluntary speech while maintaining the ability to speak and understand speech addressed to him.

Catatonic agitation, on the contrary, is characterized by the fact that patients are constantly on the move, talk incessantly, grimace, mimic the interlocutor, and are characterized by foolishness, aggressiveness and impulsiveness. The actions of patients are unnatural, inconsistent, often unmotivated and sudden; there is a lot of monotony in them, repetition of gestures, movements and poses of others. The patients' speech is usually incoherent, containing symbolic statements, rhyming, and refrains of the same phrases or statements. Continuous speech pressure can be replaced by complete silence. Catatonic excitement is accompanied by various emotional reactions - pathos, ecstasy, anger, rage, and at times indifference and indifference.

Although during catatonic agitation any verbal communication is practically impossible, and the patient’s motor activity can only be reduced with the help of medications, nevertheless the patient cannot be left in isolation, because he has impaired basic self-care skills (using the toilet, dishes, eating, etc.) and unexpected actions that are life-threatening for the patient and others are possible. Naturally, in this case we are talking about the need for emergency medical care and most likely - hospitalization.

The difficulties of caring for a patient in a state of agitation are largely due to the fact that the exacerbation of the disease often begins unexpectedly, usually at night and often reaches its peak within a few hours. In this regard, relatives of patients must act in such a way as to exclude the possibility of dangerous actions by patients in these “unadapted conditions”. The patient's relatives, friends or neighbors do not always correctly assess the possible consequences of the resulting state of excitement. The patient (a person well known to them with an established relationship) is usually not expected to pose a serious danger. Sometimes, on the contrary, an acute illness causes unjustified fear and panic among others.

Actions of relatives in case of psychomotor agitation in a patient:

Create conditions for providing assistance, eliminate, if possible, the atmosphere of confusion and panic.

If you see that you are in immediate danger, try to isolate the patient in a windowless room and call the police.

Remove piercing and other objects that the patient can use as a weapon of attack or suicide.

Remove all strangers from the patient's room, leaving only those who may be useful.

Try to calm the patient down by asking abstract questions; under no circumstances argue with him or engage in altercations.

If you have already been in a similar situation, remember your doctor’s recommendations on the use of medications that can reduce or relieve agitation.

R thinking disorders (cognitive impairment), characteristic of diseases of the schizophrenia spectrum, are associated with a loss of purposefulness, consistency, and logic of mental activity. Such thinking disorders are called formal, since they relate not to the content of thoughts, but to the thought process itself. First of all, this affects the logical connection between thoughts, in addition, figurative thinking disappears, a tendency towards abstraction and symbolism prevails, breaks in thoughts, a general impoverishment of thinking or its unusualness with the originality of associations, even absurd ones, are observed. In the later stages of the disease, the connection between thoughts is lost even within the same phrase. This manifests itself in speech impediment, which turns into a chaotic collection of fragments of phrases that are absolutely unrelated to each other.

In milder cases, there is a logical transition from one thought to another (“slipping”), which the patient himself does not notice. Thinking disorders are also expressed in the appearance of new pretentious words, understandable only to the patient himself (“neologisms”), in fruitless reasoning on abstract topics, in philosophizing (“reasoning”) and in the disorder of the generalization process, which is based on irrelevant features . In addition, there are disorders such as an uncontrollable flow or two parallel flows of thoughts.

It should be emphasized that formally the level of intelligence (IQ) in persons suffering from schizophrenia spectrum diseases differs only slightly from the IQ level of healthy people, i.e. Intellectual functioning in this disease remains quite preserved for a long time, in contrast to specific damage to cognitive functions, such as attention, the ability to plan one’s actions, etc. Less often, patients suffer from the ability to solve tasks and problems that require the use of new knowledge. Patients select words according to their formal characteristics, without caring about the meaning of the phrase, skip one question, but answer another. Some thinking disorders appear only during the period of exacerbation (psychosis) and disappear when the condition stabilizes. Others, more persistent, remain in remission, creating the so-called. cognitive deficit.

Thus, the range of schizophrenia spectrum disorders is quite wide. Depending on the severity of the disease, they can be expressed in different ways: from subtle features visible only to the eye of an experienced specialist, to sharply defined disorders, indicating a severe pathology of mental activity.

Except for thought disorders * , all of the above manifestations of schizophrenia spectrum diseases belong to the circle positive disorders(from Latin positivus - positive). Their name means that the pathological signs or symptoms acquired during the course of the disease are, as it were, added to the patient’s mental state that was before the disease.

Negative disorders(from the Latin negativus - negative), so called because in patients, due to a weakening of the integrative activity of the central nervous system, a “loss” of powerful layers of the psyche may occur due to the painful process, expressed in a change in character and personal properties. In this case, patients become lethargic, lack initiative, passive (“decreased energy tone”), their desires, motivations, aspirations disappear, emotional deficit increases, isolation from others appears, and avoidance of any social contacts. Responsiveness, sincerity, and delicacy are replaced in these cases by irritability, rudeness, quarrelsomeness, and aggressiveness. In addition, in more severe cases, patients develop the above-mentioned thinking disorders, which become unfocused, amorphous, and meaningless. Patients may lose their previous work skills to such an extent that they have to register for a disability group.

One of essential elements psychopathology of diseases schizophrenia spectrum is progressive impoverishment of emotional reactions, as well as their inadequacy and paradox. At the same time, already at the beginning of the disease, higher emotions - emotional responsiveness, compassion, altruism - can change. As their emotional decline progresses, patients become less and less interested in events in the family and at work, their old friendships are severed, and their old feelings for loved ones are lost. Some patients experience the coexistence of two opposing emotions (for example, love and hatred, interest and disgust), as well as duality of aspirations, actions, and tendencies. Much less often, progressive emotional devastation can lead to a condition emotional dullness, apathy.

Along with emotional decline, patients may also experience violations volitional activity, more often manifested only in severe cases of the disease. We can talk about abulia - partial or complete absence motivation for activity, loss of desires, complete indifference and inactivity, cessation of communication with others. Patients spend whole days, silently and indifferently, lying in bed or sitting in one position, not washing, and stopping caring for themselves. In especially severe cases, abulia can be combined with apathy and immobility.

Another volitional disorder that can develop during illness is schizophrenia spectrum is autism (a disorder characterized by a separation of the patient’s personality from the surrounding reality with the emergence of a special inner world that dominates his mental activity). In the early stages of the disease, a person who has formal contact with others, but does not allow anyone into his inner world, including the people closest to him, can also be autistic. Subsequently, the patient withdraws into himself, into personal experiences. Judgments, positions, views, ethical assessments of patients become extremely subjective. Often their unique idea of ​​the life around them takes on the character of a special worldview, and sometimes autistic fantasies arise.

A characteristic feature of schizophrenia is also decreased mental activity . It becomes more difficult for patients to study and work. Any activity, especially mental, requires more and more tension from them; Concentrating is extremely difficult. All this leads to difficulties in perceiving new information and using the stock of knowledge, which in turn causes a decrease in working capacity, and sometimes complete professional failure with formally preserved intellectual functions.

Thus, negative disorders include disorders of the emotional and volitional spheres , disorders of mental activity, thinking and behavioral reactions.

Positive disorders, due to their unusual nature, are noticeable even to non-specialists, and therefore are identified relatively easily, while negative disorders can exist for quite a long time without attracting special attention. Symptoms such as indifference, apathy, inability to express feelings, lack of interest in life, loss of initiative and self-confidence, impoverishment vocabulary and some others, may be perceived by others as character traits or as side effects of antipsychotic treatment, and not the result of a disease state. In addition, positive symptoms may mask negative disorders. But, despite this, it is the negative symptoms that have the greatest impact on the patient’s future, on his ability to exist in society. Negative disorders are also significantly more resistant to drug therapy than positive ones. Only with the advent of new psychotropic drugs at the end of the twentieth century - atypical neuroleptics (Rispolept, Zyprexa, Seroquel, Zeldox) did doctors have the opportunity to influence negative disorders.

For many years, studying endogenous diseases of the schizophrenia spectrum, psychiatrists concentrated their attention mainly on positive symptoms and searching for ways to relieve them. Only in recent years has an understanding emerged that specific changes in cognitive (mental) functions are of fundamental importance in the manifestations of schizophrenia spectrum diseases and their prognosis. They mean the ability to mentally concentrate, to perceive information, to plan one’s own activities and predict its results. In addition to this, negative symptoms can also manifest themselves in a violation of adequate self-esteem - criticism. This lies, in particular, in the inability of some patients to understand that they suffer from a mental illness and for this reason need treatment. Criticality towards painful disorders is essential for doctor-patient cooperation. Its violation sometimes leads to such forced measures as involuntary hospitalization and treatment.

THEORIES OF APPEARANCE ENDOGENOUS DISEASES OF THE SCHIZOPHRENIC SPECTRUM

Despite the fact that the nature of most mental illnesses still remains largely unclear, diseases of the schizophrenia spectrum are traditionally classified as so-called endogenous mental illnesses (“endo” translated from Greek - internal). Unlike the group of exogenous mental illnesses (“exo” - external, external), which are caused by external negative influences (for example, traumatic brain injury, infectious diseases, various intoxications), diseases of the schizophrenia spectrum do not have such distinct external causes.

According to modern scientific views, schizophrenia is associated with disturbances in the transmission of nerve impulses in the central nervous system (neurotransmitter mechanisms) and the special nature of damage to certain brain structures. Although the hereditary factor undoubtedly plays a certain role in the development of schizophrenia spectrum diseases, it is, however, not decisive. Many researchers believe that from parents, as in the case of cardiovascular diseases, cancer, diabetes and other chronic diseases, one can only inherit an increased predisposition to diseases of the schizophrenia spectrum, which can only be realized under certain circumstances. Attacks of the disease are provoked by some kind of mental trauma (in such cases, people say that the person “went crazy with grief”), but this is the case when “after does not mean as a result.” In the clinical picture of schizophrenic diseases, as a rule, there is no clear connection between the traumatic situation and mental disorders. Usually, mental trauma only provokes a hidden schizophrenic process, which would sooner or later manifest itself without any external influence. Psychotrauma, stress, infections, intoxications only accelerate the onset of the disease, but are not its cause.

FORECAST WITH ENDOGENOUS DISEASES OF THE SCHIZOPHRENIC SPECTRUM

Illnesses of the schizophrenia spectrum are not generally fatal progressive mental illnesses; they often have a relatively benign course and are amenable to the influence of psychotropic drugs. The prognosis of schizophrenia is more favorable when the disease develops at a relatively mature age and as a result of any traumatic life events. The same applies to people who are successful in school, work, have a high level of education, social activity, and ease of adaptation to change life situations. High professional opportunities and life achievements preceding the onset of the disease predict more successful rehabilitation.

The acute, dramatic development of the disease, accompanied by psychomotor agitation, makes a difficult impression on others, but it is this option the development of psychosis may mean minimal damage to the patient and the possibility of his returning to his previous quality of life. Conversely, the gradual, slow development of the first symptoms of the disease and the delayed start of treatment aggravate the course of the disease and worsen its prognosis. The latter can also be determined by the symptoms of the disease: in cases where a schizophrenia spectrum illness manifests itself predominantly in positive disorders (delusions, hallucinations), a more favorable outcome can be predicted than in cases where negative symptoms (apathy, isolation, lack of desires) come first and motives, poverty of emotions).

One of the most important factors influencing the prognosis of the disease is the timeliness of the start of active therapy and its intensity in combination with socio-rehabilitation measures.

MAIN TYPES OF FLOWENDOGENOUS DISEASES OF THE SCHIZOPHRENIC SPECTRUM

The clinical picture of schizophrenia spectrum diseases is characterized by extreme diversity, both in the combination of symptoms and in the type of their course. Domestic psychiatrists currently distinguish three main forms of schizophrenia: paroxysmal (including recurrent), paroxysmal-progressive and continuous. The progression characteristic of this disease is understood as a steady increase, progression and complication of symptoms. The degree of progression can be different: from a sluggish process to unfavorable forms.

TO continuously flowing forms Schizophrenia spectrum diseases include cases with a gradual progressive development of the disease process, with varying severity of both positive and negative symptoms. At continuous flow The symptoms of the disease are observed throughout life from the moment of illness. Moreover, the main manifestations of psychosis are based on two main components: delusional ideas and hallucinations.

These forms of endogenous disease are accompanied by personality changes. A person becomes strange, withdrawn, and commits absurd, illogical actions from the point of view of others. The range of his interests changes, new, previously unusual hobbies appear. Sometimes these are philosophical or religious teachings of a dubious nature, or fanatical adherence to the canons of traditional religions. Patients' performance and social adaptation decrease. In severe cases, the emergence of indifference and passivity, complete loss of interests, cannot be ruled out.

For paroxysmal flow ( recurrent or periodic form of the disease) characterized by the occurrence of distinct attacks combined with a mood disorder, which brings this form of the disease closer to manic-depressive psychosis, [*] Moreover, mood disorders occupy a significant place in the picture of attacks. When Moreover, mood disorders occupy a significant place in the picture of attacks. When paroxysmal During the course of the disease, manifestations of psychosis are observed in the form of separate episodes, between which there are “bright” intervals of relatively good mental state (with high level social and labor adaptation), which, being long enough, can be accompanied by complete restoration of ability to work (remission).

An intermediate place between the indicated types of flow is occupied by cases paroxysmal-progressive (fur-like) form of the disease when, in the presence of a continuous course of the disease, the appearance of attacks is noted, the clinical picture of which is determined by syndromes similar to attacks of recurrent schizophrenia.

The forms of endogenous diseases of the schizophrenia spectrum differ in the predominance of the main symptoms: delusions, hallucinations, or personality changes. When delirium dominates, we are talking about paranoid schizophrenia . When delusions and hallucinations are combined, they speak of its hallucinatory-paranoid version . If personality changes come to the fore, then this form of the disease is called simple .

A special type of schizophrenia is its low-progressive (sluggish) form- a variant of the disease characterized by a relatively favorable course, with a gradual and shallow development of personality changes, against the background of which there are no distinct psychotic states, but disorders that are dominated by neurosis-like (obsessions, phobias, rituals), psychopath-like (severe hysterical reactions, deceitfulness, explosiveness, vagrancy), affective and, less commonly, erased delusional symptoms. Modern European and American psychiatrists have removed this form from the category of “schizophrenia” into a separate so-called schizotypal disorder. In order to make a diagnosis of sluggish schizophrenia, the doctor pays attention to the personality disorders of the patients, giving their appearance features of strangeness, eccentricity, eccentricity, mannerisms, as well as pomposity and suggestiveness of speech with poverty and inadequacy of intonation.

Diagnosis of this group of conditions is quite complex and requires a highly qualified doctor, since, without paying attention to the features described above, an inexperienced doctor may mistakenly diagnose psychopathy, “neurosis”, affective disorder, which leads to the use of inadequate medical tactics and, as a consequence, to the untimeliness of therapeutic and social rehabilitation measures.

FIRST SIGNS OF THE DISEASE

Endogenous diseases of the schizophrenia spectrum most often develop over several years, and sometimes last throughout life. However, in many patients, rapid development of symptoms can occur only in the first five years from the onset of the disease, after which a relative mitigation of the clinical picture occurs, accompanied by social and labor readaptation.

Experts divide the disease process into several stages.

IN pre-morbid period Most patients do not have signs associated with manifestations of schizophrenia spectrum disorders. During childhood, adolescence and adolescence, a person who may later develop this pathology is not much different from most people. The only things that attract attention are some isolation, slight oddities in behavior and, less often, difficulties associated with learning. From this, however, one should not conclude that everyone withdrawn child, as well as all those experiencing learning difficulties, will certainly suffer from a schizophrenia spectrum disorder. Today, unfortunately, it is impossible to predict whether such a child will develop this disease or not.

IN prodromal (incubation) period The first signs of the disease are already appearing, but not yet clearly expressed. The most common manifestations of the disease at this level are as follows:

extremely valuable hobbies (a teenager or young man begins to devote a lot of time to mystical thoughts and various philosophical teachings, sometimes joins a sect or fanatically “goes” to religion);

episodic changes in perception (elementary illusions, hallucinations);

decreased ability to perform any activity (study, work, creativity);

changes in personality traits (for example, instead of diligence and punctuality, negligence and absent-mindedness appear);

weakening of energy, initiative, need for communication, craving for loneliness;

strange behavior.

The prodromal period of the disease can last from several weeks to several years (on average, two to three years). Manifestations of the disease can increase gradually, as a result of which relatives do not always pay attention to changes in the patient’s condition.

If we take into account that many teenagers and young men go through a pronounced age crisis (“adolescence”, “pubertal crisis”), characterized by sudden changes in mood and “strange” behavior, a desire for independence, independence with doubts and even rejection of previous authorities and a negative attitude towards people from the immediate environment, it becomes clear why the diagnosis of endogenous diseases of the schizophrenia spectrum is so difficult at this stage.

During the early manifestations of the disease, you should seek advice from a psychiatrist as soon as possible. Often, adequate treatment for schizophrenia begins very late due to the fact that people seek help from non-specialists or turn to so-called “traditional healers” who cannot recognize the disease in time and begin the necessary treatment.

ACUTE PERIOD OF DISEASE (HOSPITALIZATION)

Acute period The disease usually occurs after the condition described above, but it may also be the first sudden manifestation of the disease. Sometimes it is preceded by severe stress factors. At this stage, acute psychotic symptoms appear: auditory and other hallucinations, incoherent and meaningless speech, statements of content inappropriate to the situation, oddities in behavior, psychomotor agitation with impulsive actions and even aggression, freezing in one position, decreased ability to perceive the outside world as it is exists in reality. When the disease is so pronounced, changes in the patient’s behavior are noticeable even to a layman. Therefore, it is at this stage of the disease that the patients themselves, but more often their relatives, turn to the doctor for the first time. Sometimes this acute condition poses a danger to the life of the patient or others, which leads to his hospitalization, but in some cases patients begin to be treated on an outpatient basis, at home.

Patients with schizophrenia may receive specialized assistance in a psychoneurological dispensary (PND) at the place of residence, in psychiatric research institutions, in the offices of psychiatric and psychotherapeutic care at general clinics, in the psychiatric offices of departmental clinics.

The functions of the PND include:

Outpatient appointments for citizens referred by doctors of general clinics or who applied independently (diagnosis, treatment, decision social issues, examination);

Advisory and dispensary observation patients;

Emergency care at home;

Referral to a psychiatric hospital.

Hospitalization of the patient . Because people suffering from endogenous schizophrenia spectrum illness are often unaware that they are ill, it is difficult or even impossible to convince them of the need for treatment. If the patient's condition worsens, and you can neither convince nor force him to be treated, then you may have to resort to hospitalization in mental asylum without his consent. The main purpose of both involuntary hospitalization and the laws governing it is to ensure the safety of the acutely ill patient and the people around him. In addition, the tasks of hospitalization also include ensuring timely treatment of the patient, even against his wishes. After examining the patient, the local psychiatrist decides in what conditions to carry out treatment: the patient’s condition requires urgent hospitalization in a psychiatric hospital, or it can be limited to outpatient treatment.

Article 29 of the Law of the Russian Federation (1992) “On psychiatric care and guarantees of the rights of citizens during its provision” clearly regulates the grounds for involuntary hospitalization in a psychiatric hospital, namely:

“A person suffering from a mental disorder may be hospitalized in a psychiatric hospital without his consent or without the consent of his legal representative before the judge’s decision, if his examination or treatment is possible only in an inpatient setting, and the mental disorder is severe and causes:

a) his immediate danger to himself or others, or

b) his helplessness, that is, his inability to independently satisfy the basic needs of life, or

c) significant harm to his health due to a deterioration in his mental state if the person is left without psychiatric help.”

PERIOD OF REMISSION (maintenance therapy)

During the course of the disease, as a rule, several exacerbations (attacks) are observed. Between these states there is a lack of active signs of the disease - a period remission. During these periods, signs of the disease sometimes disappear or are minimally present. At the same time, each new “wave” of positive disorders makes it increasingly difficult for the patient to return to normal life, i.e. worsens the quality of remission. During remissions, in some patients, negative symptoms become more noticeable, in particular, decreased initiative and desires, isolation, and difficulties in formulating thoughts. In the absence of help from loved ones, supportive and preventive pharmacotherapy, the patient may find himself in a state of complete inactivity and neglect.

Scientific studies conducted over a number of years have shown that after the first attacks of schizophrenia spectrum diseases, approximately 25% of all patients recover completely, 50% recover partially and continue to need preventive care, and only 25% of patients require constant treatment and medical supervision, sometimes even in a hospital setting.

Maintenance therapy: The course of some forms of schizophrenia spectrum diseases differs in duration and tendency to relapse. That is why all domestic and foreign psychiatric recommendations regarding the duration of outpatient (supportive, preventive) treatment clearly stipulate its terms. Thus, patients who have suffered a first episode of psychosis need to take small doses of drugs for two years as preventive therapy. If a repeated exacerbation occurs, this period increases to three to seven years. If the disease shows signs of transition to a continuous course, the period of maintenance therapy is increased indefinitely. That is why there is a justified opinion among practical psychiatrists that in order to treat those who become ill for the first time, maximum efforts should be made, carrying out the longest and most complete course of treatment and social rehabilitation. All this will pay off handsomely if it is possible to protect the patient from repeated exacerbations and hospitalizations, because after each psychosis negative disorders increase, which are especially difficult to treat.

Psychiatrists often face the problem of patients refusing to continue taking medications. Sometimes this is explained by the lack of criticism in some patients (they simply do not understand that they are sick), sometimes the patient declares that he has already been cured, feels well and no longer needs any medications. At this stage of treatment, it is necessary to convince the patient to take maintenance therapy for the required period. The psychiatrist insists on continuing treatment not at all out of reinsurance. Practice proves that taking medications can significantly reduce the risk of exacerbation of the disease. The main drugs used to prevent relapses of schizophrenia are antipsychotics (see the section “principles of treatment”), but in some cases additional drugs can be used. For example, lithium salts, valproic acid, carbamazepine, as well as new drugs (Lamictal, Topamax), are prescribed to patients with mood disorders predominant in the picture of an attack of the disease, not only to stop this particular condition, but also to minimize the risk of recurrent attacks in future. Even with continuous flow For schizophrenia spectrum diseases, taking psychotropic medications helps achieve stable remission.

THE PROBLEM OF RECURRENCE WITHENDOGENOUS DISEASES SCHIZOPHRENIC SPECTRUM

Orderly management helps reduce the frequency of relapses Casual style life, which has the maximum therapeutic effect and includes regular exercise, rest, a stable daily routine, a balanced diet, avoidance of drugs and alcohol (if used previously) and regular intake of maintenance therapy prescribed by a doctor.

After each exacerbation (relapse), the following phenomena are noted:

Remission develops more slowly and becomes less complete

Hospitalizations are becoming more frequent

Resistance to therapy develops

It is more difficult to achieve the previous level of functioning

Self-esteem decreases, social isolation increases

Increased risk of self-harm

The burden of material costs for families and society increases

Signs of an approaching relapse may include:

Any, even minor, change in behavior or daily routine (sleep, food, communication).

Absence, excess or inadequacy of emotions or activity.

Any behavioral characteristics that were observed on the eve of a previous attack of illness.

Strange or unusual judgments, thoughts, perceptions.

Difficulties in ordinary affairs.

Discontinuation of maintenance therapy, refusal to visit a psychiatrist.

Having noticed warning signs, the patient and family should take the following measures:

Notify the attending physician and ask him to decide whether there is a need to adjust the therapy.

Eliminate all possible external stressors on the patient.

Minimize all changes in your usual daily life.

Provide as calm, safe and predictable an environment as possible.

To prevent exacerbation, the patient should avoid:

Premature withdrawal of maintenance therapy.

Violations of the medication regimen in the form of an unauthorized reduction in dosage or irregular intake (often patients skillfully hide this even with careful observation).

Emotional shocks, sudden changes (conflicts in the family or at work, quarrels with loved ones, etc.).

Physical overload, including both excessive exercise and overwhelming housework.

Colds (acute respiratory infections, flu, sore throats, exacerbations chronic bronchitis etc.).

Overheating (solar insolation, prolonged stay in a sauna or steam room).

Intoxication (food, alcohol, drug and other poisoning).

Changes in climate conditions and time zones.

ENDOGENOUS DISEASES SCHIZOPHRENIC SPECTRUM AND RISK FACTORS

Illnesses of the schizophrenia spectrum are not fatal in themselves, but their psychopathological features are such that they can end in the most tragic way. It's primarily about the possibility suicide.

THE PROBLEM OF SUICIDE DURING ENDOGENOUSDISEASES SCHIZOPHRENIC SPECTRUM

Thoughts about death often occupy people with schizophrenia. Almost a third of them cannot cope with them and make suicide attempts. Unfortunately, up to 10% of patients suffering from schizophrenia spectrum diseases die in this way.

Factors that increase the risk of suicide include frequent hospitalizations, long-term and drug-resistant disorders, delayed diagnosis and initiation of treatment, insufficient doses of medications or too short treatment periods. The risk of suicide increases due to a feeling of uncertainty in patients, which arises, for example, when discharged from the hospital too early - before the main signs of the disease disappear (sometimes this occurs due to pressure on doctors from relatives). The incidence of tragic incidents among inpatients is much lower than among those outside hospitals, but, unfortunately, such cases sometimes occur even in hospitals.

There are several conditions that increase the risk of suicide:

Most suicide attempts are carried out during the active period of the disease, i.e. in a state of psychosis, under the influence of delusional beliefs, imperative (commanding) hallucinations, confusion, fear, anxiety, especially when the latter leads to agitation (in such a situation, urgent hospitalization can be considered as a measure necessary to save the patient’s life);

Depression, which develops in diseases of the schizophrenia spectrum, also often leads patients to suicidal attempts, often ending fatally. Against the background of depression, there is a painful perception of the social and personal consequences that the disease brings. Patients are overcome by depressing thoughts about the future, about the likelihood of new hospitalizations, about possible disability and the need to take medications throughout their lives. Severe depression is dangerous because at the height of the severity of the condition, thoughts of not wanting to live may arise, and suicidal readiness arises. If there is no professional or relative nearby who can explain what is happening and provide support, the patient may fall into despair and take a fatal step. Suicidal attempts are often made at night or in the early morning hours, when no one and nothing distracts the patient from painful thoughts, and relatives are asleep or lose vigilance in relation to the patient’s behavior.

One of the most important factors risk for schizophrenia spectrum diseases is the presence of previous suicide attempts. Therefore, it is very important to know (or find out) whether the patient has had thoughts of suicide in the present or past. In many cases, timely hospitalization protects the patient from himself and is a necessary measure, even if it is carried out against his wishes.

It is known that in most cases the decision to commit suicide is not sudden - it is preceded by attempts to get help from family members or medical personnel. Talking about despair and hopelessness, even without expressing intentions to commit suicide, are direct signals of a threat of suicide that require the most serious consideration.

The following signs warn of the possibility of suicide:

The patient’s statements about his uselessness, sinfulness, and guilt.

Hopelessness and pessimism about the future, reluctance to make any life plans.

The patient's belief that he has an incurable disease.

Sudden calming of the patient after a long period of melancholy and anxiety (others may have the false impression that the patient’s condition has improved and the danger has passed).

Discussing specific suicide plans with the patient.

Measures to prevent suicide:

Take any conversation on the topic of suicide seriously and pay attention to them, even if it seems unlikely to you that the patient could commit suicide.

Do not ignore or minimize the severity of the patient’s condition; explain to him that feelings of depression and despair can occur in anyone, and that relief will certainly come over time.

· If it seems that the patient is already preparing for suicide, seek professional help immediately.

· Hide dangerous objects (razors, knives, ropes, weapons, medicines, other chemicals), carefully close windows and balcony doors, do not leave the patient alone, do not let him out into the street without an escort.

· Do not be afraid to “offend” your relative with involuntary measures - when he comes out of depression, he will feel a sense of gratitude for the fact that you prevented the irreparable.

THE PROBLEM OF ALCOHOL AND DRUG ABUSE BY PATIENTS

Another problem that rightfully relates to risk factors is - high frequency of abuse of psychoactive substances (drugs and alcohol) by persons suffering from endogenous diseases of the schizophrenia spectrum. Many patients see psychoactive substances a cure for despair, anxiety, depression and loneliness. It is no coincidence that the proportion of patients using these drugs as self-medication reaches 50%.

The use of drugs by some patients complicates the diagnosis and treatment of schizophrenia spectrum diseases and complicates the rehabilitation process. For example, the similarity between symptoms caused by drug use and symptoms of diseases of the schizophrenic circle, masking the signs of the disease, can lead to errors in diagnosis and delays in prescribing treatment. Drugs also have an adverse effect on the course of the disease: it begins at an earlier age, the frequency of exacerbations increases, the ability to perform any activity sharply decreases, and a pronounced tendency to violence appears. It is also known that patients taking drugs respond much worse to antipsychotic therapy, which is associated with increased resistance of their body to both drugs and rehabilitation measures. Such patients are hospitalized much more often, for longer periods, and their treatment outcomes are much worse. Among patients taking drugs, the suicide rate is significantly higher (approximately four times).

Almost the same dangerous factor risk, like the use of drugs, in these diseases is alcohol abuse. Patients who resort to alcohol in an attempt to cope with feelings of uncertainty and fear of the future risk worsening their condition and the outcome of treatment.

SOCIAL DANGER

(aggressiveness of persons suffering from schizophrenia spectrum diseases)

This problem is somewhat exaggerated due to the outdated attitude towards the mentally ill as dangerous people. The roots of this phenomenon can be found in the recent past. However, studies conducted in recent years have shown that the frequency of aggressive behavior and violence among patients is no higher than among the rest of the population, and that aggressive behavior appears in patients only during a certain period. For example, these are the days when an exacerbation began, and the patient has not yet been hospitalized. This danger disappears during hospital treatment, but may reappear after discharge. Having left the “closed walls”, the patient feels vulnerable, unprotected, suffers from uncertainty and self-doubt, from the wrong attitude of members of society towards him. All these are the main reasons for the manifestation of aggressiveness. At the same time, books and films describing patients with schizophrenia as serial killers or rapists, are very far from reality. Aggression, inherent only in a small part of patients, is directed, as a rule, only against family members, especially parents.

There is a clear connection between the level of aggressiveness and what a patient in a psychotic state experiences. A patient who is experiencing a situation of immediate threat to life (delusions of persecution) or “hears” in the content of auditory hallucinations a discussion of plans to reprisal against him, flees in panic or attacks imaginary pursuers. At the same time, outbreaks of malicious hostility are accompanied by severe aggression. In these cases, it is necessary to remember that the actions of such a patient may not correspond to the behavior of a healthy person in a situation similar to a delusional plot. One should not count on behavior that is understandable to others and logical within the patient’s delusional system. On the other hand, when dealing with an excited delusional patient, we must not forget that you can help him only if you establish a trusting relationship with him, even if before this he carried out any aggressive actions. It is important to understand that a patient, even one in a psychotic state, can and should be reassured by subsequently taking the necessary measures to help him professional help, including urgent hospitalization and pharmacological treatment.

PROBLEMS OF INTERACTION WITH PERSONS SUFFERING ENDOGENOUS DISEASES SCHIZOPHRENIC SPECTRUM, THEIR FAMILY ENVIRONMENT

With the introduction of new drugs into the therapeutic arsenal for the treatment of diseases of the schizophrenic range, patients began to spend more and more time outside the hospital, which leads to significant difficulties in some families. As a rule, most often relatives of patients are faced with their isolation, reluctance or fear of entering into social relationships. Patients with severe negative symptoms look detached, sloppy, they are slow, do not take care of themselves, avoid communication, and their range of interests is sharply limited. The behavior of many patients is characterized by strangeness, pretentiousness, and is not always predictable and socially acceptable. For this reason, relatives of patients themselves are often in a state of depression, constant anxiety, uncertainty about the future, confusion, and feel guilty. In addition, conflicts arise due to disagreements between family members regarding the attitude and treatment of the patient, and even more often due to a lack of understanding and sympathy on the part of neighbors and friends. All these factors seriously complicate the lives of relatives, and ultimately the patients themselves.

Public organizations working in the field of mental health could provide significant assistance in solving this problem, but, unfortunately, in our country this area of ​​assistance to families of the mentally ill is practically absent or is in the process of formation. More detailed information about these organizations can be found in the section of this book dedicated to psychosocial rehabilitation.

Family members need to know that:

Patients suffering from schizophrenia usually require long-term treatment.

During the treatment process, temporary exacerbations and relapses are almost inevitable.

There is a certain amount of the patient's ability to do household chores, work or communicate with other people, which should not be exceeded.

It is not advisable to require a patient who has just been discharged from the hospital to immediately begin work or study.

Excessive care with underestimation of the requirements for a mentally ill person only causes harm.

Many patients, even with a long course of the disease, are able to keep themselves clean, be polite and participate in family affairs.

Mentally ill people find it difficult to endure situations when they are shouted at, irritated, or required to do something they are not capable of.

Family psychotherapy helps the patient and his close relatives understand each other's point of view. It, as a rule, covers work with the patient himself, his parents, sisters and brothers, spouses and children, and can be used both to mobilize family support for the patient and to support family members who are in a difficult mental state. There are different levels of family therapy, from one or two conversations to regularly scheduled meetings. From the first days of hospitalization, doctors attach special importance to cooperation with the patient’s family members. It is important for a doctor providing family therapy to establish communication with his relatives so that they always know where to turn with their problems. Awareness about the disease and its consequences, about treatment and its importance, about various types of medical interventions is a powerful tool that can influence readiness for long-term treatment, and therefore influence the disease itself. As part of family therapy early first At the stage of illness, efforts are concentrated on problematic issues in relationships between family members, because “unhealthy” relationships can affect the patient and sometimes even cause a deterioration in his condition. At the same time, a great responsibility is placed on the closest relatives, since they have the opportunity to significantly help the patient, improving the quality of life of both himself and all the people around him.

In families of patients with schizophrenia, there may be several incorrect lines (models) of behavior, in which psychotherapists see the sources of many difficulties and failures. The features of these models can lead to conflicts and frequent exacerbations of the disease. The first of these models is relationships built on an excess of reactions of irritability and criticism. That is, instead of making a comment on a specific issue (for example, about getting out of bed late), an irritated relative resorts to generalizations and offensive statements that hurt the character and personality of the patient (“Look how lazy you are,” etc. ). In principle, you can make comments to the patient, but you should avoid anger and ill will, the sources of which lie in the person accusing him. Criticism should be as specific and constructive as possible. The next pattern of incorrect behavior is a combination of exaggerated guilt and anxiety. Feelings of guilt very often stem from insufficient awareness of the patient’s relatives about his illness and the idea that parents may allegedly be to blame for its occurrence in their children. Excessive involvement and anxiety are considered normal in certain cultures and are expressed in greater closeness, greater protection and in the inability to see the sick family member as an independent and different person, with his own character, desires, positive and negative qualities. Excessive care can lead to a delay in the mental development of the patient, to the formation of his symbiotic dependence on the family and, as a result, to the progression of the disease. Even when these efforts of the patient’s relatives are based on love and the desire to help him, in most cases they are perceived negatively by the patient, causing him irritation and internal resistance, together with a feeling of failure, guilt and shame.

Family therapists try to point out to relatives the pathological forms of their relationships with patients, highlight the positive emotions and interests behind them, and provide more “correct” forms of relationships, cemented by friendly participation. There are several ways to quickly and significantly improve your relationship. Briefly, they boil down to the following recommendations: show true interest in the speaker; You shouldn’t tell everyone at the same time; transfer the “right of conversation” from one to another, and not constantly assign it to oneself; no need to say O person, and With by a person; do not talk to relatives about the patient as if he is not in the room, because this creates in the patient the feeling that he does not exist.

Often, an additional problem is the excessive concentration of family concerns on the patient with a lack of attention to other family members (his brothers or sisters), as well as to the personal and social life of the parents themselves. In such cases, it is recommended to include various “pleasures” in family plans, devote time to personal entertainment, and, in general, do not forget to “carry on with life.” A disappointed person, dissatisfied with his life, will not be able to make others happy, even if he tries very hard.

A “proper” family is one in which everyone is tolerant of others; in which a healthy person can see the world through the eyes of a sick person, and at the same time “introduce” him to the surrounding reality, without confusing these worlds. The chance of positive change and achieving a stable state is greater when family therapy begins at an early level, before family members' behavior patterns are established.

PRINCIPLES OF TREATMENTENDOGENOUS DISEASESSCHIZOPHRENIC SPECTRUM

In most cases, with the development of acute schizophrenic psychosis, patients require hospitalization. The latter has several goals. The main one is the ability to organize constant monitoring of the patient, allowing doctors and medical staff to detect the slightest changes in his condition. At the same time, the picture of the disease is clarified, a somato-neurological and laboratory examination is carried out, and psychological tests are performed. These measures are necessary to exclude other mental illnesses with similar symptoms. At the end of the examination, drug treatment is prescribed, trained personnel constantly monitor the effectiveness of the therapy, and the doctor makes the necessary adjustments and monitors the possibility of side effects.

In uncomplicated and unadvanced cases, inpatient treatment for a psychotic state usually lasts one and a half to two months. This is exactly the period the doctor needs to cope with acute symptoms disease and select the optimal supportive therapy. If, during a complicated course of the disease, its symptoms turn out to be resistant to the drugs used, it may be necessary to change several courses of therapy, which leads to an increase in hospital stay.

Although medicine does not yet know how to completely cure endogenous diseases of the schizophrenia spectrum, nevertheless, there are various types of therapy that can bring the patient not only significant relief, but also practically eliminate relapses of the disease and completely restore his working capacity.

Neuroleptics are most often used to treat endogenous diseases of the schizophrenia spectrum. The second most common group of medications used in the treatment of schizophrenia are antidepressants. Some of them have a predominantly calming effect, others have a stimulating effect, and therefore the latter may not only not reduce the manifestations of psychosis, but, on the contrary, strengthen it. Therefore, doctors are forced to carefully select antidepressants, taking into account the clinical characteristics of each specific case of the disease. Sometimes it is necessary to use a combination of several drugs to achieve the desired effect.

In the early stages of psychopharmacotherapy dating back to the fifties of the twentieth century, the main drugs for the treatment of schizophrenia were the so-called first-generation antipsychotics (the so-called “classical” antipsychotics): aminazine, haloperidol, stelazine, etaprazine, neuleptil, chlorprothixene, eglonil, sonapax and others , used in psychiatric practice at the present time. The drugs listed above can reduce the severity of the positive symptoms of the disease (psychomotor and catatonic agitation, aggressive behavior, hallucinations and delusions), but, unfortunately, they do not have enough effect on the negative symptoms. Naturally, all these drugs differ from each other in the degree of their effectiveness for different patterns of mental disorders and the nature of side effects. It is impossible to predict in advance which medicine will help a given patient with sufficient accuracy, so the doctor usually empirically (experimentally) selects the most effective drug or combination of drugs. The correct choice of these drugs and treatment regimens help reduce the number of relapses and exacerbations of the disease, prolong remissions, improve the quality of life of patients and increase the level of their social and labor adaptation.

Significant progress in the treatment of endogenous diseases of the schizophrenia spectrum has occurred in the last 10 - 15 years with the introduction into psychiatric practice of a new generation of neuroleptics (so-called atypical antipsychotics), which include risperidone (Rispolept), olanzapine (Zyprexa), quetiapine (Seroquel) and ziprasidone (Zeldox). These drugs have the potential to have a powerful effect on positive and negative symptoms with a minimum of side effects. The modern pharmaceutical industry is currently developing other new generation antipsychotic drugs (azenapine, aripiprazole, sertindole, paliperidone, etc.), but they are still undergoing clinical testing.

Antipsychotics are usually taken daily as tablets or drops. Tablets are taken 1-3 times a day (depending on the doctor’s prescription). The effectiveness of their action decreases if the drugs are taken together with antacids(reducing the acidity of gastric juice), containing aluminum or magnesium salts, oral contraceptives. For ease of use, tablets can be crushed into powder, drops can be mixed with juice (not apple, grapefruit or orange). This is appropriate to do in cases where there is doubt that the patient is actually taking the pills. Rispolept solution should not be added to tea or drinks such as Coca-Cola.

In the arsenal of modern psychopharmacotherapy there are prolonged dosage forms(the so-called depot), which allows you to create a uniform concentration of the drug in the blood for 2-4 weeks after a single injection. These include fluanxol-depot, clopixol-depot, haloperidol-decanoate, moditene-depot, and the first atypical antipsychotic - rispolept-Consta.

Since the introduction of psychopharmacotherapy into psychiatric practice, there has certainly been noticeable progress in the treatment of diseases of the schizophrenia spectrum. The active use of traditional antipsychotics has helped alleviate the suffering of many patients, making possible not only inpatient but also outpatient treatment. However, over time, evidence has accumulated that these drugs, later called, as mentioned above, “classical” neuroleptics, act predominantly only on positive symptoms, often practically without affecting the negative ones: hallucinations and delusions disappear, but the patient remains inactive, passive, cannot return to work. In addition, almost all classical antipsychotics cause side effects, manifested by muscle stiffness, convulsive twitching of the limbs, difficult to tolerate feelings of restlessness, dry mouth, or, conversely, increased salivation. Some patients experience nausea, constipation, palpitations, decreased blood pressure, etc. Thus, although the need to use antipsychotics for long-term treatment In patients with schizophrenia, there is no doubt that the long-term use of traditional antipsychotics is associated with a number of difficulties. This forces clinicians to increasingly resort to the latest generation of neuroleptics - atypical antipsychotics - for the treatment of schizophrenia spectrum diseases.

Based on this, the modern stage of the “fight” against diseases of the schizophrenia spectrum is characterized by the constant development and introduction of ever new drugs, including those with prolonged action, which makes it possible to improve treatment, ensure differentiated prescription of certain drugs, minimize their side effects and achieve greater results. successes in overcoming therapeutic resistance to drugs. When choosing appropriate medications, psychiatrists are guided by advances in biochemistry and the collective experience of pharmacologists and clinical researchers accumulated over the past decades. Study of the structure of the human brain and its diseases using the latest techniques- this is an area in which scientists around the world have invested a lot of effort and money in recent years, which is already bearing fruit in the form of new drugs, more selective and effective, better tolerated by patients.

REQUIREMENTS FOR AN IDEAL ANTIPSYCHOTIC

An ideal drug for the treatment of schizophrenia spectrum diseases would be a drug that allows equally effectively: active therapy , which relieves both positive and negative symptoms of the disease during an attack or exacerbation; maintenance therapy aimed at preserving improvement achieved and stabilization of the condition; preventive therapy , the purpose of which is to prevent relapses of the disease and prolong remissions.

Domestic psychiatry was brought closer to solving this problem by introducing clinical practice a fundamentally new generation of neuroleptics - atypical antipsychotics. By selectively acting only on certain nerve receptors, these drugs turned out to be, on the one hand, more effective, and on the other, much better tolerated. In addition, it turned out that atypical antipsychotics relieve, along with positive psychopathological symptoms, negative symptoms. Currently, drugs such as Rispolept, Zyprexa, Seroquel, and Zeldox are increasingly used for active and preventive treatment of psychosis. The first atypical antipsychotic, clozapine (Leponex, Azaleptin), is also quite widely used in psychiatric practice. However, its use is limited due to severe side effects (weight gain, constant drowsiness, drooling), and also due to the fact that a patient taking clozapine must undergo regular blood tests due to possible changes in its formula.

When drug therapy for mental disorders is required, an unconventional, strictly individual approach is required. An important aspect in this work is the need for close cooperation between the patient and the doctor. The specialist’s task is to achieve the patient’s interest and participation in the therapy process. Otherwise, there may be a violation of medical recommendations regarding doses and medication regimen.

The doctor needs to instill in the patient faith in the possibility of recovery, overcome his prejudice against the mythical “harm” caused by psychotropic drugs, and convey to him his conviction in the effectiveness of treatment, subject to systematic adherence to the prescribed prescriptions. It is important to explain to the patient that the effect of most psychotropic drugs develops gradually . Therefore, before starting therapy, in order to avoid disappointment and premature termination of the course of treatment, patients are warned that the potential of the drug may not appear immediately, but with a certain delay.

Thus, the main drugs of choice for maintenance and preventive treatment of endogenous diseases of the schizophrenia spectrum are atypical antipsychotics. Their advantage, first of all, is the absence of such unpleasant side effects as lethargy, drowsiness, restlessness, slurred speech, and unsteady gait. In addition, atypical antipsychotics are distinguished by a simple and convenient dosing regimen: almost all drugs of the new generation can be taken once a day (for example, at night), regardless of food intake. Of course, it cannot be said that atypical antipsychotics are completely free of side effects. When taking them, a slight increase in body weight, decreased potency, disruption of the menstrual cycle in women, and increased levels of hormones and blood sugar may be observed. However, almost all of these phenomena occur as a result of taking the drug in dosages higher than recommended and are not observed when using average therapeutic doses. Regular monitoring may also help prevent some side effects. somatic condition the patient and his weight. A serious disadvantage of atypical antipsychotics is their cost. All new drugs are produced abroad and, naturally, have a high price. For example, the average monthly cost of treatment with Zyprexa is $200-400, Zeldox - $250-350, Seroquel - $150-300, Rispolept - $100-150.

It should be added that today there are no known methods, with the exception of pharmacotherapy, that can cure a person from severe forms of endogenous diseases of the schizophrenia spectrum, and in some cases, medications can only weaken the severity of the symptoms of the disease and improve the quality of life of patients and their loved ones. At the same time, we should not forget that in some types of schizophrenia the disease occurs in attacks, even severe ones, but not leading to a defect and intermittent remissions of good quality at the level of practical recovery.

Modern medications used to treat schizophrenia spectrum diseases are very effective, but even they are not always able to eliminate all signs of the disease. Even when the disease recedes, it is very difficult for the patient to adapt to society. Schizophrenia spectrum diseases often affect young people at an age when they should receive an education, master a profession, and start a family. Psycho-social rehabilitation and psycho-pedagogical treatment help to cope with these tasks and the additional problems arising from them.

PSYCHO-SOCIAL REHABILITATION

Being a set of programs for training patients with mental disorders in ways of rational behavior both in a hospital setting and at home, psychosocial rehabilitation is aimed at developing social skills necessary in everyday life, such as interacting with other people, accounting for one’s own finances, cleaning the house, committing shopping, using public transport, etc. These activities are not intended for patients in acute period diseases when their connection with the real world is unstable. The importance of psychosocial rehabilitation increases from the moment the severity of the process decreases. Its goals include preventing recurrent attacks and improving adaptation in school, work and personal life.

Psychotherapy helps mentally ill people feel better about themselves, especially those who experience feelings of inferiority as a result of their illness and those who deny the existence of their own illness. Although psychotherapy alone cannot cure the symptoms of schizophrenia spectrum illnesses, individual and group sessions can provide important moral support and create a friendly atmosphere that is very beneficial for both the patients themselves and their loved ones.

An important element of social rehabilitation is participation in mutual support groups led by patients who have undergone hospitalization. This allows other patients to feel help in understanding their problems, to realize that they are not alone in their misfortune, to see opportunities for personal participation in rehabilitation activities and in public life.

Psychosocial rehabilitation involves various systems of influence, including individual conversations (psychotherapy), family and group therapy, rehabilitation, support groups, etc. In addition to family therapy, which was discussed above, individual psychotherapeutic treatment is carried out, which consists of regular meetings between the patient and a professional, who can be a psychiatrist, psychologist or social worker with special training. During the conversations, various topics of concern to the patient are discussed: past experiences and existing difficulties, thoughts, feelings and relationship systems. The patient and his mentor jointly discuss problems that are relevant to the patient, separate the real from the imaginary and try to find the optimal solution to the existing problems.

By analyzing his past with an experienced and relatable mentor, the patient receives Additional information to develop a new perspective on yourself and your problems. In contrast to psychotherapy for other mental health conditions, people with schizophrenia spectrum disorders benefit from special benefit from conversations relating to the real world and daily concerns. These conversations provide the support they need and a stable “connection with reality.” At the same time, it is also important to develop personal connections among patients and support their desire to create and preserve them.

Group therapy sessions typically involve a small number of patients and a facilitator. This system focuses on teaching each group member from the experiences of others, comparing other people's perceptions of reality and developing an approach to personal relationships; At the same time, distortions are corrected based on feedback from other patients. In the group you can talk about drug treatment, difficulties in taking medications, side effects and common stereotypes and prejudices in society. Thanks to mutual participation and advice from group members, it is possible to solve specific problems, for example, discuss the reasons that interfere with regular medication use, and jointly look for a way out of difficult situations. In groups, various problems that concern patients are solved, such as excessive demands on themselves and others, loneliness, difficulties of inclusion in a team, and others. The patient sees that there are people around him who are experiencing the same difficulties as himself, from the example of others he learns to overcome them and is in an environment that he understands and where he is understood. Creating groups of people or families interested in helping themselves and others with similar conditions is an important initiative and a great responsibility. Such groups are very important for the restoration of personal qualities: they give patients the opportunity to communicate, cooperate, solve many problems, and provide support in creating and developing personal connections. These groups are also important at the level of socialization of the individual: they help overcome social prejudices, mobilize material funds and other resources, and provide support for the study and treatment of the disease.

Now in Moscow there are already a number of public organizations related to the problems of schizophrenia spectrum diseases. To introduce you to some of them, we provide below brief information about their activities, addresses, telephone numbers:

Organization "Public Initiatives in Psychiatry". Promotes the development of public initiatives and programs aimed at improving the quality of life of people with mental health disorders. Provides assistance in the creation of public organizations among mentally ill people and their relatives, as well as among professionals. Carries out information activities on mental health issues. Promotes the receipt of free legal assistance for persons with mental disorders.

Address: Moscow, Srednyaya Kalitnikovskaya st., 29

Telephone: 270-85-20

Charitable foundation for helping relatives of the mentally ill. Provides assistance in emergency situations caring for mentally ill or elderly patients during the absence of their relatives (during the day, several hours); provides information support to families of mentally ill people. "Rainbow". Provides free assistance to persons under the age of 26 with disabilities diagnosed with cerebral palsy, mental retardation and schizophrenia. The organization has workshops that create conditions for the realization of creative abilities.

Address: Moscow, Trofimova str., 11-33

Phone: 279-55-30

PSYCHO-EDUCATIONAL TREATMENT

One of the main tasks set when writing this book, which is also part of psycho-pedagogical treatment, was to provide information about endogenous diseases of the schizophrenia spectrum in the most accessible form to patients, their families and the entire society, burdened with prejudices and myths regarding mental illness.

Most people suffering from endogenous diseases of the schizophrenia spectrum understand that they are sick and strive for treatment, although in the initial stages of the disease it is difficult for a person to accept it. A person's ability to make decisions about his or her own treatment is greatly enhanced if family members are involved and approve and support their decisions.

The essence of the psycho-educational method lies in training and instructing the patient and his relatives. It is carried out in the form of lectures devoted to such topics as: “main symptoms”, “course and prognosis of the disease”, “treatment methods”, “possible difficulties”, etc. Recently, the Internet has played a major role in this work. Created and mental health resources supported by the Mental Health Research Center such aswww.schizophrenia.ru , www . psychiatry . ru , attract the attention of the widest public. For reference: since the opening of these sites (summer 2001), Internet users have accessed their pages more than 10,000,000 times, and up to 1,500 people visit them daily. Web portal ( www . psychiatry . ru ) has several thousand web pages. There is a forum and online consultations where anyone can ask a question that interests them or discuss a problem that concerns them. The web portal consistently holds first place among similar resources of scientific organizations. The information policy of the sites, in addition to covering narrow psychiatric problems, is aimed at forming a public view of domestic and foreign psychiatry in general. Public awareness contributes to the inclusion of patients in normal life and increases their opportunities to return to a full-fledged existence. Awareness of patients reduces internal resistance to treatment, eliminates unjustified suspicions about the harm of drugs, and creates conditions for building a strong therapeutic alliance between doctor and patient. Extensive information about the disease helps to accept it, while denial of the disease leads to refusal of treatment and inevitable deterioration of health. It is hoped that in the future society will treat individuals those suffering from endogenous diseases of the schizophrenia spectrum, as well as patients with diabetes, heart disease, liver disease, etc.

CONCLUSION

An endogenous disease of the schizophrenia spectrum, without a doubt, is a difficult test, but if Fate has prepared this difficult burden for you or your relative, the main thing that the patient’s relatives and the patient himself must do in order to cope with the disease is to develop the right attitude towards it. To do this, it is very important to come to terms with this disease. Reconciling does not mean giving in. Rather, it means recognizing the very fact of the disease, that it will not simply disappear and that the disease imposes some restrictions on everything, including the patient’s capabilities. This means the need to accept, sadly as it may be, what exists contrary to your wishes. However, it is well known that as soon as a person begins to reckon with his illness, a very heavy burden falls from his shoulders. This burden will be much lighter if all the people around the patient can understand special treatment to life - they will learn to accept it as it is, and this is precisely what is vital if there is a patient in the family. Such reconciliation will allow people, although they perceive the disease as one of the dramatic events in their lives, at the same time it will not allow it to constantly fill their existence and the hearts of loved ones with bitterness. After all, there is still a whole life ahead.

* In this case, we are talking only about painful changes in mood; psychologically understandable reactions of grief, depression, for example, after the loss of a loved one, bankruptcy, as a result of “unhappy love,” etc. are not considered here. or, on the contrary, an elevated, euphoric mood after a successful session, marriage, or other joyful events.

* Thought disorders can refer to both positive symptoms (if observed at the height of psychosis) and negative ones if they appear during remission

Objective: to study the genetic characteristics of familial cases of paranoid schizophrenia in comparison with sporadic ones in Russians using the example of the population of the Saratov region. The study involved patients with paranoid schizophrenia with a family history of schizophrenia (n=30) and patients with paranoid schizophrenia without a family history of the disease (n=140). We studied the Val66Met polymorphism (Val and Met alleles) for the brain-derived neurotrophic factor gene (rs6265 G>A), the C939T polymorphism (C and T alleles) of the type 2 dopamine receptor gene DRD2 (rs6275C>T) and the T102C polymorphism (T and T alleles). C) the 5-HTR2A gene (rs6313), encoding the serotonin receptor type 2A. The study confirmed the presence of genetic features of familial paranoid schizophrenia, which is characterized by a predominance of maternal inheritance and a higher frequency of the TT genotype for the C939T polymorphism of the DRD2 gene (rs6275). Further study of the molecular genetic features of familial forms will allow us to get closer to understanding the mechanisms of etiopathogenesis of schizophrenia.

family cases

paranoid schizophrenia

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3. Sukhorukov V.S. Mitochondrial pathology and problems of the pathogenesis of mental disorders // Journal of Neurology and Psychiatry named after. C.C. Korsakov. – 2008. - T. 108, No. 6. – P. 83–90.

4. Aberrant tyrosine transport across the fibroblast membrane in patients with schizophrenia-indications of maternal inheritance? / Flyckt L, Edman G, Venizelos N, Borg K. // J Psychiatr Res. 2011. Vol. 45. P. 519-525.

5. Li X, Sundquist J, Sundquist K. Age-specific familial risks of psychotic dis-orders and schizophrenia: a nation-wide epidemiological study from Sweden // Schizophr Res. 2007. Vol. 97. P. 43–50.

6. Morris G, Berk M. The many roads to mitochondrial dysfunction in neuroimmune and neuropsychiatric disorders // BMC Med. 2015 Apr 1;13:68. doi: 10.1186/s12916-015-0310-y. URL: http://www.biomedcentral.com/1741-7015/13/68 (date accessed: 10/10/2015).

The etiology and pathogenesis of schizophrenia are currently not well understood. Nevertheless, the genetic hypothesis of schizophrenia is generally accepted. It is based on the results of a study of hereditary predisposition in schizophrenia, which showed the accumulation of cases of the disease in families of patients with schizophrenia, data on the concordance of twins for schizophrenia. The existence of familial cases of schizophrenia confirms the hereditary nature of the disease. Genetic determination with a polygenic non-Mendelian type of inheritance, which is inherent in schizophrenia, is determined not by one specific gene, but by a set of variant alleles at several chromosomal loci that create a hereditary predisposition to the development of the disease. Modern molecular genetic studies of schizophrenia pay special attention to the risk of morbidity for relatives, frequency, type of inheritance, and prognosis for subsequent generations. The urgency of the problem is associated with the relatively high frequency of familial cases of schizophrenia in the population of patients with endogenous psychoses. Clinical features of familial cases of schizophrenia with a predominance of the paranoid form are reported.

Purpose of the study

To study the genetic characteristics of familial cases of paranoid schizophrenia in comparison with sporadic cases.

Materials and methods

We examined 206 patients with paranoid schizophrenia (97 women, 109 men; age range - from 18 to 60 years inclusive; average age in years = 31.2 ± 0.71), Russian by nationality, with of varying duration diseases admitted for treatment to psychiatric hospitals in Saratov and the Saratov region due to exacerbation of the schizophrenic process. The main selection criteria were the diagnosis of paranoid schizophrenia “F20.0” verified by an inpatient examination (in accordance with the diagnostic criteria of ICD-10), and somatic well-being. Exclusion criteria were the presence of concomitant mental disorders, a history of traumatic brain injury, and refusal to cooperate during the interview.

History and demographic data were collected during clinical interviews and during inpatient chart review. The diagnosis of mental disorder was determined using the diagnostic criteria of the International Classification of Diseases, Tenth Revision ICD-10.

In 36 patients, reliable and consistent information about the hereditary burden of schizophrenia could not be identified during a detailed study of the family tree. In 140 examined patients (63 women, 77 men), there was no hereditary history of schizophrenia; in 30 patients (19 women, 11 men), the case of schizophrenia was determined to be familial, which amounted to 17.6%. A case of schizophrenia was defined as familial if the patient had at least one relative (grandparents, aunts, uncles, parents, brothers, sisters and children) with this disease. Only probands were genotyped and examined.

The study was approved by the Ethics Committee of the State Budgetary Educational Institution of Higher Professional Education “Saratov State Medical University named after. IN AND. Razumovsky" (protocol No. 2 of October 13, 2009). All subjects gave informed consent to participate in the study.

The study material was peripheral venous blood of patients taken from the cubital vein. Materials for genotyping were sent to the laboratory of clinical genetics of the National Center for Clinical Genetics of the Russian Academy of Medical Sciences (head of the laboratory, Doctor of Biological Sciences V.E. Golimbet), where DNA was isolated from blood samples using the phenol-chloroform method. We studied the Val66Met polymorphism (Val and Met alleles) for the brain-derived neurotrophic factor gene (rs6265 G>A), the C939T polymorphism (C and T alleles) for the type 2 dopamine receptor gene DRD2 (rs6275C>T) and the T102C polymorphism (T and T alleles). C) the 5-HTR2A gene (rs6313), encoding the serotonin receptor type 2A.

Study of the relationship between pairs of discrete qualitative signs was carried out using analysis of paired contingency tables. In addition to the estimates of the Pearson Chi-square test and the achieved level of statistical significance of this criterion, an assessment of the intensity of the relationship of the analyzed characteristics was calculated using the Cramer V coefficient. This part of the statistical analysis was carried out at the Biostatistics Center (headed by V.P. Leonov, Ph.D.). Statistical analysis procedures were performed using statistical packages SAS 9.3, STATISTICA 10 and IBM-SPSS-21. The critical value of the level of statistical significance when testing null hypotheses was taken equal to 0.05. If the achieved level of significance of the statistical criterion for this value was exceeded, the null hypothesis was accepted.

results

A low frequency of recurrence of schizophrenia was found in the family cases we studied (2, less often 3 patients in one family), which is consistent with the literature data and indicates in favor of a non-Mendelian type of inheritance and a polygenic predisposition to schizophrenia.

In five cases (16.7%), secondary schizophrenic psychoses were observed in brothers and sisters of the probands. In 16 observations (53.3%), the founders of the disease were mothers or maternal relatives of probands, in 9 observations (30%) - fathers or paternal relatives of probands. The results obtained confirm the view that there is a tendency towards maternal inheritance in patients with schizophrenia, which can be explained by the involvement of the mitochondrial genome in the processes of inheritance of schizophrenia.

An analysis of allele frequencies for polymorphisms rs6265, rs6275, rs6313 in patients with paranoid schizophrenia was carried out, taking into account family history. In the examined patients with relatives with schizophrenia, the occurrence of allele C of the C939T polymorphism of the DRD2 gene in the genotype was significantly lower than in patients without a family history of schizophrenia. The allele frequencies of the rs6265 and rs6313 polymorphisms did not differ between the groups of familial and sporadic variants of paranoid schizophrenia (Table 1).

Table 1

Frequency of alleles in the studied polymorphic regions in patients with paranoid schizophrenia in groups with the presence (n=30) and absence (n=140) of family history

At the next stage, an analysis of the frequencies of genotypes of the studied polymorphisms in groups of patients with schizophrenia was carried out, taking into account family history. Among familial cases of paranoid schizophrenia, the TT genotype for the Cr939T polymorphism of the DRD2 gene (rs6275) was significantly more common than in the group of patients without a family history of the disease. When comparing the occurrence of genotypes of the rs6265 and rs6313 polymorphisms between groups of patients with paranoid schizophrenia, taking into account family history, no differences were found. The results obtained are clearly presented in Table 2.

table 2

Frequency of genotypes in the studied polymorphic areas of patients suffering from paranoid schizophrenia in groups with the presence (n=30) and absence (n=140) of family history

Note. The genotype frequency is given; in brackets - number of carriers

The study confirmed the presence of genetic features of familial paranoid schizophrenia, which is characterized by a predominance of maternal inheritance and a higher frequency of the TT genotype for the C939T polymorphism of the DRD2 gene (rs6275). Further study of the molecular genetic features of familial forms will allow us to get closer to understanding the mechanisms of etiopathogenesis of schizophrenia.

Barylnik Yu.B., Doctor of Medical Sciences, Head of the Department of Psychiatry, Saratov State Medical University named after. IN AND. Razumovsky" of the Ministry of Health of Russia, deputy chief physician of the State Healthcare Institution "Regional Clinical Psychiatric Hospital of St. Sophia", chief freelance child psychiatrist of the Ministry of Health of the Saratov Region, Saratov;

Semke A.V., Doctor of Medical Sciences, Professor, Deputy Director for Scientific and Medical Work of the Federal State Budgetary Institution “Research Institute of Mental Health” of the Siberian Branch of the Russian Academy of Medical Sciences, Tomsk.

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Scientists from the Institute of Medical Research Neuroscience Research Australia and the University of New South Wales announced that they have found the “culprits” of one of the most severe mental illnesses - schizophrenia. Experts believe that these are immune cells person. The work carried out by specialists can change doctors’ usual ideas about this disease, and therefore open up more opportunities for developing methods for its treatment.

As a rule, when hearing the word “schizophrenic,” many people imagine a person who is distinguished by extremely unusual behavior - from eccentricity to demonstration of extreme aggression. What do we know and should know about this disease? Psychologist and psychotherapist Tahmasib Javadzade, in a conversation with Sputnik Azerbaijan, spoke about the features of this disease, its symptoms, as well as interesting cases from his practice.

© Sputnik/Murad Orujov

— How difficult is it to work with patients with schizophrenia?

- Of course, it’s difficult. When I first started working at the hospital, I had a headache for two weeks straight. Over time I began to get used to it. When my students come to my work, they feel this whole aura around the patients and ask how I can work there. And I answer that this is my job and everything here has already become familiar to me.

— How or from what can a person get schizophrenia?

— There are a number of diseases that people consider schizophrenia, but this is not so. It is necessary to distinguish, for example, between neurosis and psychosis. Neurosis is a treatable disorder. It includes dozens of diseases, and they are treated. These include phobias, panic attacks and others.

Psychosis is a more serious and dangerous disorder, usually of a hereditary nature. And the most common disease in this case is schizophrenia. People with schizophrenia pose a danger to themselves and others. In this case, the exacerbation of the disease occurs in autumn and spring. Unfortunately, it is impossible to completely recover from this disease; drugs only alleviate the patient’s condition.

© Sputnik/Murad Orujov

— Do they treat patients only inpatiently?

— Patients take medications on schedule, and therefore they are treated in hospitals. True, patients often want to be treated at home, or even refuse to take medications. If patients do not admit their illness, they do not take medicine at home, this only aggravates their condition, as a result, the sick person can harm and injure themselves and those around them. This is especially common in patients with personality disorders.

-What do you mean by personality disorder?

- Such people do not see problems in themselves. It seems to them that everyone around them is sick, but not them.

— Is the disease most often inherited?

— The disease can pass to a person from father, mother or the closest relative. There is a high probability that the disease will be passed on from an aunt or uncle on the paternal or maternal side. The most severe form is observed in people whose parents suffer from schizophrenia.

© Sputnik/Murad Orujov

When you ask the parents of such patients - “why did you marry your children, you knew that they were sick?” They answer: “They wanted grandchildren.” And they do not understand that a sick grandson is a heavy moral burden for them, and a danger for them. of the entire society. It is categorically impossible to allow a marriage between two patients with schizophrenia. These people should not create families at all. Children born in such a marriage sometimes suffer from mental retardation, and they have no future.

- As I understand it, there are different types schizophrenia...

- Yes, there are simple, mixed, paranoid and other forms of the disease. The most difficult one is paranoid. Patients with paranoid schizophrenia can suspect any person of anything and even injure him. For example, when I was studying in Iran, I came across an interesting case. A man cut off the heads of his wife and children at night. Then he himself came to the police and confessed everything. The man claimed that he killed them because “his wife was unfaithful and the children were strangers.”

— How do patients with paranoid schizophrenia differ from others?

- At first glance they are no different from ordinary people. They just can suspect anyone of anything. These people hear voices. They claim that someone is talking to them and giving orders. They even see what their brain “invented”.

- Do they see genies and devils?

- Well, genies and shaitans do not exist, science rejects them, and there is no evidence of their existence. And patients simply see what they have come up with for themselves. They don’t see like normal people, they see everything in smoke and fog. But the voices are heard clearly. They even talk to animals and trees. One of our patients with paranoid schizophrenia said: “My father injects people with expired medications.” I asked him if he looked at the dates on these drugs and he said, “No.” But he was sure that his father was injecting poison into people, and even drove out patients who came to their home shouting: “Run, save yourself!”

— Similar symptoms observed in women who have just given birth...

— After the birth of a child, changes occur in the mother’s body. After giving birth, a woman should not be left alone for several months. During this period, the risk of developing schizophrenia increases sharply. In some cases, relatives do not attach importance to the symptoms of the disease, and in the end this leads to tragedy.

By the way, when I was still a student, one of our relatives committed suicide. People close to him said that “lately he was not himself, insulted neighbors for no reason, made scandals at home, talked to himself.” And the family did not suspect that the man had paranoid schizophrenia and therefore committed suicide.

“Sometimes older people talk to long-dead people and hear some sounds. Can a person develop schizophrenia in old age?

- No. All this - senile psychoses. This can often be observed in older people.