Schizophrenia is a fairly common mental illness. It is manifested by disturbances in thinking, perception, emotional-volitional disorders and inappropriate behavior. The term “schizophrenia” was proposed by the Swiss psychopathologist E. Bleuler. Literally it means “splitting of the mind” (from the ancient Greek words “σχίζω” - split and “φρήν” - reason, mind).
Historical information about schizophrenia
The first information about schizophrenia-like symptoms dates back to 2000 BC. From time to time, many prominent physicians from different eras also described similar psychotic disorders. In his work “The Medical Canon,” Avicenna spoke about severe madness, partly reminiscent of schizophrenia. Pathology began to be studied in more detail only at the end of the 19th century. The German psychiatrist E. Kraepelin (1856-1926) observed adolescent patients suffering from various psychoses. In the process of research, he found that after some time all patients developed a similar state of special dementia. It was called “dementia praecox” (dementia praecox). Other psychiatrists supplemented and expanded information about the symptoms, course and outcomes of this disease. At the beginning of the twentieth century, the Swiss psychopathologist E. Bleuler proposed introducing a new name for the disease - “schizophrenia”. He proved that pathology occurs not only at a young age, but also in adulthood. Its characteristic feature is not dementia, but a “violation of the unity” of the psyche. The proposed concept of schizophrenia was recognized by all psychiatrists.
Early symptoms of schizophrenia
The early symptoms are the same as in other psychotic illnesses, but “they are experienced at a milder, subthreshold level. Key symptoms to look for: suspiciousness, unusual thoughts, changes in sensory experience (hearing, seeing, touching, tasting or smelling things that others do not experience. Disorganized communication: the person has difficulty getting to the point of a conversation, incoherence, illogical reasoning, and grandiosity - unrealistic beliefs about one's abilities or talents. Just having at least one of these symptoms is the biggest predictor of psychosis by far, even greater than having a parent with schizophrenia. In fact, according to recent research, 35 percent of people who had one of these symptoms, developed psychosis within 2.5 years.During this time, patients progressed through all stages.Substance use, such as alcohol and marijuana, has been shown to increase the risk of early symptoms.
Why does schizophrenia develop?
Despite the high level of development of modern medicine, it has still not been possible to establish the exact cause of this disease. Psychiatrists are more inclined to the genetic theory of the occurrence of schizophrenia. It says: if there is a person with schizophrenia in the family, then his blood relatives have a high risk of developing this pathology. However, the mode of inheritance and molecular genetic basis of the disease are unknown. An important role in the development of schizophrenia is played by personality traits, low social status (poverty, poor living conditions, dysfunctional family, etc.), various diseases (drug addiction, alcoholism, chronic somatic pathologies, traumatic brain injuries, prolonged psychotraumatic situations, etc.) Sometimes The onset of schizophrenia is preceded by stress, but in most patients schizophrenia occurs “spontaneously.”
If one of the parents suffers from schizophrenia, the child cannot avoid a similar fate
It is believed that parents with schizophrenia give birth to a mentally ill child. This statement is fundamentally incorrect. Heredity cannot be ruled out, but it is not the disease that is transmitted, but the tendency to it. Therefore, it is wrong to give up on a child whose mother and father or one of them suffers from schizophrenia.
The theoretical probability of inheriting the disease is estimated at 67-88%. But in reality the numbers are not so scary:
- in identical twins (even those with a genetic predisposition) - 45-47%;
- Mom or dad is sick - 14%, both - 45%;
- the diagnosis was made to close relatives – about 5%.
Various types of research continue to establish the degree of inheritance of schizophrenia. But so far the results are mixed and preliminary. Scientists already know specific genes that can trigger the development of the disease. This is revealed by reading genetic information and carefully studying it.
More precise data were obtained by trying to link this disease to changes in the gene component of several candidates. Thus, the majority of schizophrenics have a polyform type of serotonin, dopamine and COMT genes. But their presence can also be associated with other mental disorders. So, even if there is a complete breakdown of the genotype, it is impossible to give an accurate forecast of whether a person will develop schizophrenia or not.
Treatment programs
Treatment of depression
Panic attacks
Treatment of schizophrenia
Neuroses, phobias
Typical forms of the disease
Typical forms of schizophrenia include paranoid, hebephrenic, catatonic and simple forms.
Paranoid form (F20.0)
Most often in their practice, psychiatrists encounter the paranoid form of schizophrenia. In addition to the main signs of schizophrenia (impaired thinking, autism, decreased emotions and their inadequacy), the clinical picture of this form is dominated by delirium. It typically manifests as delusions of persecution without hallucinations, delusions of grandeur, or delusions of influence. Signs of mental automatism may occur when patients believe that someone from the outside is influencing their own thoughts and actions.
Hebephrenic form (F20.1)
The most malignant form of schizophrenia is hebephrenic. This form is characterized by manifestations of childishness and silly, absurd excitement. Patients grimace, can laugh for no reason, and then suddenly become indignant, show aggression and destroy everything in their path. Their speech is inconsistent, full of repetitions and words they have invented, and very often accompanied by cynical abuse. The disease usually begins in adolescence (12-15 years) and progresses rapidly.
Catatonic form (F20.2)
The clinical picture of the catatonic form of schizophrenia is dominated by motor dysfunction. Patients remain in unnatural and often uncomfortable positions for long periods of time without feeling tired. They refuse to follow instructions and do not answer questions, although they understand the words and commands of the interlocutor. Immobility in some cases (catalepsy, a symptom of a “mental (air) cushion”) is replaced by attacks of catatonic excitement and impetuous actions. In addition, patients can copy facial expressions, movements and statements of their interlocutor.
Simple form (F20.6)
The simple form of schizophrenia is characterized by an increase in exclusively negative symptoms, in particular, apathetic-abulic syndrome. It is manifested by emotional poverty, indifference to the world around us, indifference to oneself, lack of initiative, inactivity and rapidly increasing isolation from the people around us. At first, a person refuses to study or work, breaks off relationships with relatives and friends, and wanders. Then, gradually, he loses his accumulated knowledge and develops “schizophrenic dementia.”
Atypical forms of the disease
In the clinic of atypical forms of schizophrenia, non-standard, not entirely characteristic signs predominate. Atypical forms include schizoaffective psychosis, schizotypal disorder (neurosis-like and variant), febrile schizophrenia and some other forms of schizophrenia.
Schizoaffective psychosis (F 25)
Schizoaffective psychosis is a special condition that is characterized by the paroxysmal occurrence of schizophrenic (delusional, hallucinatory) and affective symptoms (manic, depressive and mixed). These symptoms develop during the same attack. At the same time, the clinical picture of the attack does not meet either the criteria for manic-depressive psychosis or the criteria for schizophrenia.
Schizotypal disorder (neurosis-like variant) (F 21)
The neurosis-like variant of schizotypal disorder is manifested by asthenic, hysterical symptoms or obsessive phenomena that resemble the clinic of the corresponding neuroses. However, neurosis is a psychogenic reaction to a traumatic situation. Schizotypal disorder is a disease that occurs spontaneously and does not correspond to existing frustrating experiences. In other words, it is not a response to a stressful situation and is characterized by absurdity, deliberateness, and isolation from reality.
Febrile schizophrenia
In extremely rare cases, acute psychotic states with signs of severe toxicosis occur, called febrile schizophrenia. Patients experience a high temperature, and the symptoms of somatic disorders increase (subcutaneous and intraorgan hemorrhages, dehydration, tachycardia, etc.). The clinic of mental disorders is characterized by clouding of consciousness, the appearance of delusions of fantastic content and catatonic syndrome. Patients are confused, rush around in bed, make meaningless movements, cannot say who they are and where they are. Febrile schizophrenia should be distinguished from neuroleptic malignant syndrome. This is a fairly rare life-threatening disorder associated with the use of psychotropic drugs, most often antipsychotics. Neuroleptic malignant syndrome is usually manifested by muscle rigidity, increased body temperature, autonomic changes and various mental disorders.
Rare forms of delusional psychoses
Rare forms of delusional psychoses include chronic delusional disorders (paranoia, late paraphrenia, etc.), acute transient psychoses.
Chronic delusional disorders (F22)
This group of psychoses includes various disorders in which chronic delusions are the only or most noticeable clinical sign. The delusional disorders observed in patients cannot be classified as schizophrenic, organic or affective. It is likely that the reasons for their occurrence are genetic predisposition, personality traits, life circumstances and other factors. Chronic delusional disorders include paranoia, tardive paraphrenia, paranoid psychosis, and paranoid schizophrenia with sensitive relational delusions.
Paranoia (F22.0)
Patients suffering from paranoia are often suspicious, touchy, and jealous. They tend to see the machinations of ill-wishers in random events, remember grievances for a long time, do not accept criticism, and treat the people around them with acute distrust. Often they have overvalued delusional ideas of grandeur and/or persecution, on the basis of which patients are able to build complex logical conspiracy theories directed against themselves. Often those suffering from paranoia write a huge number of complaints against imaginary ill-wishers to various authorities, and also begin lawsuits.
Acute transient psychoses (F23)
The clinical picture of acute transient psychosis develops after a fleeting period of confusion, anxiety, restlessness and insomnia. Psychosis is characterized by the appearance of acute sensory delirium with rapid changes in its structure. Most often, delusional ideas of influence, persecution, relationships, staging, false recognition and delusions of a double arise. Hallucinatory experiences, true auditory and pseudohallucinations are possible. As a rule, they are unstable and prone to changing each other quickly.
Clinical picture
Many symptoms of schizophrenia appear in childhood in a reduced form; they are erased, uniform, and monotonous. Severe productive symptoms are observed relatively rarely (Mestas C., 1957), anxiety, irritability, and uncertainty dominate.
In childhood schizophrenia, clear impairments in the cognitive sphere are found, manifested by difficulties communicating with peers and a noticeable decrease in academic performance.
With the early onset of schizophrenia in childhood, quite pronounced disorders of the autonomic nervous system are recorded, sleep disturbances, appetite disturbances, and general lethargy are noted.
A relatively common symptom of the onset of childhood schizophrenia is a feeling of fear.
At an early age, fear is unconscious; at the age of 2-3 years it is already objective: fear of people, cars, trains, bridges, darkness, etc. For children with schizophrenia aged 5-7 years, nighttime obsessive fears are , accompanied by waking up, checking closed doors, listening to various sounds, and rudimentary hypnagogic hallucinations are less common.
A sick child early reveals a pathology of drives , shows indifference or aggression towards the mother, acquires unusual habits, and at the same time he may have no reaction to discomfort.
At the age of 4-5 years, cruelty towards peers and perverse attractions are noticeable. The child’s fantasies include the theme of death and disaster (Bashina V.M., 1989).
Affective mood swings and a tendency toward erased depressive states are common psychopathological formations in adolescent schizophrenia. There may be a paradoxical combination of thanatophobia with suicidal tendencies.
In adolescence, schizophrenia can manifest itself as a heboid syndrome with symptoms of autochthonous mood swings and periodically occurring dysphoric reactions.
Those around him note the strangeness of the teenager’s attractions, his indifference and emotional coldness towards close people, and his opposition to generally accepted norms of behavior. The heboid teenager is characterized by sexual disinhibition and sadistic sexual fantasies.
Relatively early, a teenager with schizophrenia shows interest in alcohol, drugs, vagrancy, and theft .
With age, a child with schizophrenia becomes “stuck” on an idea.
Psychopathological overvalued formations determine the behavior of a teenager, which is often characterized by destructive tendencies. Sometimes the patient is prejudiced against one of his peers, teases or tortures pets.
For children with schizophrenia, lethargy and slowness of movements are more typical, and hyperactivity is less common.
According to V.N. Klinkova (1992), with an increase in the degree of malignancy of early childhood schizophrenia, the following dynamics of non-verbal behavior are noted: mobility of the upper part of the face is replaced by hypomimia with rare blinking, then playing with the fingers appears with increased mobility, stereotypical grooming-like gestures. The author noted that already six months before the manifestation of the process in children, one can detect increased mobility of the oral zone and proboscis facial expressions, in particular, peculiar forms of a smile.
The clinical picture of childhood schizophrenia may be dominated by symptoms of hypochondria, developing against the background of an altered sense of self.
Hallucinations in children with schizophrenia are most often verbal in nature, but visual hallucinations also occur. “Voices” can call for violence, destruction, a negative attitude towards loved ones, in some cases they frighten the child, causing a pronounced feeling of fear.
Delusions in childhood and adolescent schizophrenia usually include ideas of persecution in their content.
Continuous schizophrenia
This type of schizophrenia is characterized by steadily progressive dynamics. Depending on the degree of its progression, a malignant, moderately progressive and sluggish course is distinguished. With a continuous course, there are periods of exacerbation of schizophrenia symptoms and their weakening. However, full-fledged high-quality remissions are not observed. The clinical and social prognosis for the majority of such patients is unfavorable. The vast majority of patients undergo inpatient treatment or are in psychoneurological boarding schools. All of them sooner or later receive the first group of disability. In some patients, many years after the onset of the disease, the clinical manifestations somewhat decrease and, thanks to this, they are kept at home, remaining unable to work.
Early intervention for schizophrenia
There are several stages in the development of the disease. So what can you do if you think your loved one is showing these early signs? There are clinics that offer services, usually including regular screenings, for at-risk youth and their families. Early screening aims to reduce the risk of developing schizophrenia, delay its onset (which research shows gives a better prognosis for the disease), reduce severity once the disease begins, and improve outcomes in all areas.
The longer the disease goes untreated, the more impaired is a person's ability to learn, work, make friends, and interact comfortably with others. A combination of early diagnosis and early intervention is best for these people. Currently, drug treatment is the mainstay used to minimize hallucinations, help a person think more clearly, focus on reality, sleep better and improve overall quality of life. However, decades of research have shown that psychosocial methods are also important for relieving symptoms and improving the quality of life of patients in the early stages of schizophrenia.
A team approach to treatment is key. The treatment team may include a psychiatrist and a psychotherapist. There are also many other professionals who can help, including psychiatric nurses, occupational psychologists and occupational therapists. When creating a team, it is good to select people who will:
- Serve as the primary point of contact to help patients navigate the system.
- Assist patients in achieving functional goals (eg, finding an apartment and/or job).
- Ensuring that patients receive good medical care, understand what treatment options are available, and learn how to use them correctly.
- Related problems are treated. (Substance abuse is the most common co-occurring symptom, but early physical problems may also be present. Be sure to find the right professional to treat early co-occurring problems.)
If you are looking for a psychiatrist, look for professionals who specialize in schizophrenia. Visit two or three different doctors, and ask them about the treatment options they practice, their results, their team (for example, do they have their own team of professionals that they work with)? How do they come together as a team? And what can this team do for you?
Periodic (recurrent) schizophrenia
With this type of schizophrenia, attacks of productive mental disorders occur periodically and are not accompanied by profound personality changes. Their number varies. Some people have one attack in their entire life, others have several, and others have more than ten. Attacks of schizophrenia can last from several days to several months. They can be of the same type (similar to each other) or heterogeneous (dissimilar to each other). The medical and social prognosis for periodic schizophrenia is usually quite favorable. This is explained by the insignificant severity of negative personal changes or their absence due to persistent intermission or practical recovery. The prognosis worsens with the severity, lengthening and frequency of attacks of recurrent schizophrenia.
Changes in behavior and habits
Among the external signs of schizophrenia that indicate its onset, the first to be distinguished are strange behavior. The patient withdraws into himself and withdraws from people. Can sit for hours in a closed room and lie on the bed. Signs of apathy are growing. Stereotype of movements increases.
One of the pathognomonic symptoms at the dawn of schizophrenia is paragnomena. This is a discouraging, unexpected behavior of the patient that is not typical in the normal state. For example, he cuts all his clothes into small pieces, arguing that this way he can put them in his closet more compactly.
The patient seems to go with the flow, submitting to all life circumstances, does not try to improve his existence, does not strive for achievements, to realize his plans.
A typical, characteristic sign of schizophrenia at an early stage is loss of interest in previously significant interests and hobbies. For example, a person used to be fond of cycling and rode a bicycle for several hours almost every day. Perhaps he took part in competitions. And then abruptly, for no apparent reason, he abandoned what he loved, settled at home, and isolated himself.
But he develops new passions. A fascination with the supernatural and metaphysical becomes typical. Often the subject of interest for patients is psychology, philosophy, mysticism, even if previously he was not interested in these areas at all. But most often, patients begin to get involved in religion. Scientists attribute this to the whimsicality and inconsistency of religious images and paintings, which reject and question the generally accepted norms of development of the world around us. Subsequently, these images become the subject of delusional ideas and hallucinations.
A person stops caring about anything at all. He even stops performing basic hygiene procedures: brushing his teeth, washing himself, and becomes unkempt and sloppy. His clothes are dirty, his hair is disheveled, but he doesn’t care what he looks like.
In another case, he spends an unusually long time on water procedures. For example, patients are able to spend several hours in the shower.
Strange cravings appear. The patient can go to a landfill, collect garbage and bring it home, accumulating mountains of unnecessary trash there. There may be a craving for theft and arson. But there are also pleasant changes: patients delve deeper into reading. But this is also pathological in nature, since they tend to read everything that catches their eye.
They forget about food and are able to go without food for several days. Or they come up with fancy diets, or they prefer to eat only one specific product.
Body dysmorphic disorder is a symptom that is a manifestation of many mental disorders. Including schizophrenia. A person becomes convinced that some part of the body is deformed. Too big nose, thick legs, protruding ears. In fact, these organs do not bring any resonance to his appearance.
The patient can hide his concern or, conversely, tell others, use any means to hide the “flaw”. His fixation can be detected when he stands for hours near the mirror, looking for poses in which his “flaw” is not so noticeable. He refuses to be photographed and hides his photos from others. This distorted self-perception sometimes leads to suicide attempts. That is, the patient cannot tolerate his imaginary deficiency to such an extent that he is unable to exist with it.
In general, a person is isolated from society, withdraws into himself, becomes greedy with emotions and strange in behavior.
These signs of the disease are often ignored. Or such people cause resentment among loved ones, bewilderment and irritability among other people. As a rule, people consult a doctor only in cases when the symptoms begin to blossom and hallucinations and delusions appear in the arena.
All early symptoms of schizophrenia are characterized by incompleteness, vagueness and episodicity. This causes difficulties in making a diagnosis, confusing doctors. Therefore, they are in no hurry to issue a final conclusion until typical signs appear.
Although many patients are absolutely sure that they are healthy, there are also those who imply that something is happening to them. They study information about their mental state, eventually finding a rationale for it, and are even able to make the correct diagnosis for themselves.
This is how one young man describes his medical history. It started around age 25. At first it was a pathological fixation on the mistake. If he heard a word that sounded wrong to him, he began to repeat other words starting with that letter. This allowed him to relieve tension. For a while, such a ritual even brought pleasure.
In another case, an unpleasant event, for example, a broken cup, caused him to create a sequence in his thoughts, a sequence of reverse actions: from a negative result to the beginning of the event. It also brought him joy and relieved his anxiety for a while. But if something interrupted his thoughts, he had to start again.
Each time it seemed that it would end soon. But as soon as any incident happened, everything would repeat itself. It happened that, while composing his chains, he spent 20 hours in bed or walked around the room.
Soon voices appeared, whispering unpleasant thoughts. They were so obvious that the patient felt as if they were his own. Then the sounds around me intensified. We had to wear headphones because they really irritated our hero. It happened like this: a car passed by, and he looked at it with a different look. Then you had to look again, right. There was a fear that the car would drive away and he would not complete his ritual.
During this time, he repeatedly consulted doctors until, finally, a diagnosis was made and the correct treatment was prescribed.
Paroxysmal-progressive schizophrenia
The most common paroxysmal-progressive course of schizophrenia occurs. This variant of the course is characterized by the presence of episodic attacks of schizophrenia with incomplete, low-quality remissions. Each attack leads to a personality defect, as well as increased delusions and hallucinations. The degree of progression of fur coat-like schizophrenia and the depth of the mental defect may vary. The clinical and social prognosis of this type of schizophrenia is determined by the rate of increase in personality changes, as well as the duration, frequency and severity of attacks. Fur-like schizophrenia with a rapidly developing mental defect has an unfavorable prognosis. A relatively favorable prognosis for sluggish fur-like schizophrenia. It is characterized by the rare occurrence of attacks that are non-psychotic in nature. The remaining cases are at intermediate levels between the indicated extreme options.
Schizophrenia in the elderly
Schizophrenia in old age is also a very rare phenomenon.
The problem is that its symptoms are mistaken for senile dementia until persistent delusions and hallucinations appear. Schizophrenia in an elderly person begins to manifest itself with suspicion and fears that they want to harm him, they want to offend him. Such a patient is wary of people, usually with aggression. Assuming danger from every stranger, a person isolates himself from society, withdraws into himself and hides from the whole world. He becomes what is called a “nasty old man.”
The emotions of old people with schizophrenia are inadequate. They laugh or cry inappropriately, and their mood changes quickly. In another case, their behavior is characterized by shyness and excessive modesty. Or there is emotional dullness, lack of emotion. Speech is distorted, it is characterized by paucity of statements and confusion. Often people simply remain silent.
Episodic derealization is observed when the patient does not understand where he is, what era he lives in, and does not recognize his loved ones. Depersonalization is expressed in a lack of understanding of who one is.
A characteristic symptom is the appearance of deceased relatives, friends, and acquaintances to the patient.
In old age, the paranoid form of the disease develops more often than others.
Differential diagnosis of schizophrenia
The diagnosis of schizophrenia is established after the duration of the disease has exceeded six months. In this case, there must be a significant impairment of social adaptation or ability to work. At its core, schizophrenia is a diagnosis of exclusion. To establish it, it is necessary to exclude affective disorders, alcoholism and drug addiction, which could lead to the development of psychopathological symptoms. Enormous difficulties arise in the differential diagnosis of catatonic and paranoid forms of schizophrenia from the corresponding forms of somatogenic, infectious, toxic, traumatic and other exogenous psychoses during their long-term course. The basis for constructing a diagnosis is specific clinical manifestations: emotional dullness, disturbances in the harmony of thinking and volitional disorders.
Publications in the media
Schizophrenia is a mental illness of a continuous or paroxysmal course, begins mainly at a young age, is accompanied by characteristic personality changes (autization, emotional-volitional disorders, inappropriate behavior), thought disorders and various psychotic manifestations. Frequency - 0.5% of the population. 50% of beds in psychiatric hospitals are occupied by patients with schizophrenia.
Genetic aspects . A priori, polygenic inheritance seems most likely. Non-scientific application of a broader definition of schizophrenia leads to an increase in population frequency estimates to 3%. The existence of several loci that contribute to the development of schizophrenia has been proven or suggested ( • SCZD1, 181510, 5q11.2‑q13.3; • amyloid b A4 precursor protein, AAA, CVAP, AD1, 104760, 21q21.3‑q22.05; • DRD3 , 126451, 3q13.3; SCZD3, 600511, 6p23; SCZD4, 600850, 22q11‑q13; EMX2, 600035, 10q26.1.
CLINICAL PICTURE
Clinical manifestations of schizophrenia are polymorphic. Various combinations of symptoms and syndromes are observed.
Negative symptoms . In psychiatry, the term “negative” means the absence of certain manifestations inherent in a healthy person, i.e. loss or distortion of mental functions (for example, impoverishment of emotional reactions). Negative symptoms are decisive in diagnosis.
• Thinking disorders. Patients with schizophrenia rarely have only one type of impaired thinking; usually a combination of different types of thought disorder is noted • • Diversity. Minor features of everyday things seem more significant than the object as a whole or the general situation. Manifested by ambiguity, vagueness, and thoroughness of speech • • Discontinuity. There is no semantic connection between concepts while the grammatical structure of speech is preserved. Speech loses its communication properties, ceases to be a means of communication between people, retaining only its external form. Characterized by a gradual or sudden deviation in the thought process towards random associations, a tendency towards symbolic thinking, characterized by the coexistence of the direct and figurative meaning of concepts. There are sudden and incomprehensible transitions from one topic to another, a comparison of the incomparable. In extreme cases, speech is devoid of semantic meaning and is inaccessible to understanding if it is constructed outwardly correctly. In severe cases of disrupted thinking, the patient spews out a sequence of completely unrelated words, and pronounces them as one sentence (verbal okroshka) • • Sperrung (blockage of thinking) - an unexpected break in the train of thought or a long delay in the thought process, loss of the thread of conversation. The disorder occurs with clear consciousness, which is different from absence seizure. The patient begins his thought or answer and suddenly stops, often in the middle of a sentence. • • Reasoning - thinking with a predominance of florid, unsubstantial, empty and fruitless reasoning, devoid of cognitive meaning • • Neologisms - new words invented by the patient, often by combining syllables taken from different words; the meaning of neologisms is understandable only to the patient himself (for example, the neologism “tabushka” is created from the words “stool” and “cabinet”). To the listener they sound like absolute nonsense, but to the speaker these neologisms are a kind of reaction to the inability to find the right words.
• Emotional disorders •• Emotional disorders in schizophrenia are manifested primarily by the extinction of emotional reactions, emotional coldness. Due to decreased emotionality, patients lose their sense of affection and compassion for loved ones. Patients become unable to express any emotions. This makes it difficult to communicate with patients, causing them to withdraw even more into themselves. Patients in the later stages of schizophrenia do not have strong emotions; if they appear, one should doubt whether the diagnosis of schizophrenia was correctly made. Emotional coldness manifests itself first and to the greatest extent in feelings towards parents (usually the patient responds to the care of parents with irritation; the warmer the attitude of the parents, the more obvious the patient’s hostility towards them). As the disease progresses, such dulling or atrophy of emotions becomes more and more noticeable: patients become indifferent and indifferent to their surroundings . great caution. People with schizophrenia exhibit both positive and negative emotions, although not as strongly as healthy people. Some people with schizophrenia, who appear to have no emotions, actually live a rich emotional inner life and have a hard time experiencing their inability to express emotions • • Ambivalence. The coexistence of two opposing tendencies (thoughts, emotions, actions) towards the same object in the same person at the same time. It manifests itself as the inability to complete certain actions or make a decision.
• Volitional disorders. Emotional disorders are often associated with decreased activity, apathy, lethargy and lack of energy. A similar picture is often observed in patients who have suffered from schizophrenia for many years. Severe volitional disorders lead to an unconscious withdrawal from the outside world, a preference for the world of one’s own thoughts and fantasies, divorced from reality (autism). Patients with severe volitional disorders look inactive, passive, and lacking initiative. As a rule, emotional and volitional disorders are combined with each other; they are designated by the same term “emotional-volitional disorders.” Each patient has an individual relationship between emotional and volitional disorders in the clinical picture. The severity of emotional-volitional disorders correlates with the progression of the disease.
• Personality changes result from the progression of negative symptoms. They manifest themselves in pretentiousness, mannerism, absurdity of behavior and actions, emotional coldness, paradox, and unsociability.
Positive ( psychotic ) manifestations . The term “positive” (“productive”) in psychiatry means the appearance of states that are not characteristic of a healthy psyche (for example, hallucinations, delusions). Positive symptoms are not specific to schizophrenia, because also occur in other psychotic conditions (for example, organic psychoses, temporal lobe epilepsy). The predominance of positive symptoms in the clinical picture indicates an exacerbation of the disease.
• Hallucinatory-paranoid syndrome is manifested by a combination of poorly systematized, inconsistent delusional ideas, often persecution, with a syndrome of mental automatism and/or verbal hallucinations • • For the patient, apparent images are as real as objectively existing ones. Patients actually see, hear, smell, and do not imagine. For patients, their subjective sensory sensations are as valid as those emanating from the objective world • • The behavior of a patient experiencing hallucinations seems crazy only from the point of view of an outside observer; to the patient himself it seems quite logical and clear • • Delusions and hallucinations are considered one of the most important and common symptoms of schizophrenia, but one symptom is not enough to diagnose this disease. Many patients with schizophrenia with a whole range of other symptoms, such as thought disorders, emotional and volitional disorders, have never observed delusions or hallucinations. It must also be remembered that delusions and hallucinations are inherent not only in schizophrenia, but also in other mental illnesses, so their presence does not necessarily indicate that the patient has schizophrenia.
• Mental automatism syndrome (Kandinsky–Clerambault syndrome) is the most typical type of hallucinatory-paranoid syndrome for schizophrenia. The essence of the syndrome is the feeling of the violent origin of disorders, their “madeness” • • Alienation or loss of belonging to one’s “I” of one’s own mental processes (thoughts, emotions, physiological functions of the body, movements and actions performed), the experience of their involuntary, madeness, imposition from the outside. Characteristic symptoms of openness, withdrawal of thoughts and mentism (an involuntary influx of thoughts) • • Pseudo-hallucinations (sensations and images that arise involuntarily without a real stimulus, differing from hallucinations in the patient’s lack of a sense of the objective reality of these images) • • Mental automatism syndrome usually accompanies systematized delusions of persecution and impact. Patients no longer belong to themselves - they are at the mercy of their persecutors, they are puppets, toys in their hands (sense of mastery), they are under the constant influence of organizations, agents, research institutes, etc.
• Paraphrenic syndrome is a combination of expansive delusions with delusions of persecution, auditory hallucinations and (or) mental automatisms. In this state, along with complaints about persecution and influence, the patient expresses ideas about his world power, cosmic power, calls himself the god of all gods, the ruler of the Earth; promises the creation of heaven on earth, the transformation of the laws of nature, radical climate change. Delusional statements are characterized by absurdity, grotesqueness, statements are given without evidence. The patient is always at the center of unusual and sometimes grandiose events. Various manifestations of mental automatism and verbal hallucinosis are observed. Affective disorders manifest themselves in the form of elevated mood, which can reach the level of mania. Paraphrenic syndrome, as a rule, indicates the age of onset of schizophrenia.
• Capgras syndrome (a delusional belief that people around them are capable of changing their appearance for a specific purpose).
• Affective-paranoid syndrome •• Depressive-paranoid syndrome is manifested by a combination of depressive syndrome, delusions of persecution, self-blame, verbal hallucinations of an accusing nature • • Manic-paranoid syndrome is manifested by a combination of manic syndrome, delusions of grandeur, noble origin, verbal hallucinations of an approving, praising nature .
• Catatonic syndrome •• Catatonic stupor. Characterized by increased muscle tone, catalepsy (freezing for a long time in a certain position), negativism (unreasonable refusal, resistance, opposition to any outside influence), mutism (lack of speech with a intact speech apparatus). Cold, uncomfortable posture, wet bed, thirst, hunger, danger (for example, a fire in a hospital) are not reflected in any way on their frozen, amicable face. Patients remain in the same position for a long time; all their muscles are tense. A transition from catatonic stupor to excitement and vice versa is possible • • Catatonic excitement. Characterized by an acute onset, suddenness, chaoticity, lack of focus, impulsiveness of movements and actions, senseless pretentiousness and mannerisms of movements, absurd unmotivated exaltation, aggression.
• Hebephrenic syndrome. Characterized by silly, ridiculous behavior, mannerisms, grimacing, lisping speech, paradoxical emotions, impulsive actions. May be accompanied by hallucinatory-paranoid and catatonic syndromes.
• Depersonalization-derealization syndrome is characterized by a painful experience of changes in one’s own personality and the surrounding world that cannot be described.
Depression in schizophrenia
Depressive symptoms in schizophrenia (both during exacerbation and in remission) are often observed. Depression is one of the most common causes of suicidal behavior in patients with schizophrenia. It should be remembered that 50% of patients with schizophrenia make suicide attempts (15% are fatal). In most cases, depression is due to three reasons.
• Depressive symptoms may be an integral part of the schizophrenic process (for example, when depressive-paranoid syndrome predominates in the clinical picture).
• Depression can be caused by awareness of the severity of their illness and the social problems that patients face (narrowing of their social circle, misunderstanding on the part of loved ones, being labeled as “crazy,” work maladjustment, etc.). In this case, depression is a normal personality reaction to a serious illness.
• Depression often occurs as a side effect of antipsychotic medications.
CLASSIFICATION
The division of schizophrenia according to its clinical forms is carried out according to the predominance of a particular syndrome in the clinical picture. This division is conditional, because only a small number of patients can be confidently classified as one type or another. Patients with schizophrenia are characterized by significant changes in the clinical picture during the course of the disease, for example, at the beginning of the disease the patient is noted to have a catatonic form, and after a few years he also experiences symptoms of the hebephrenic form.
Forms of schizophrenia
• The simple form is characterized by a predominance of negative symptoms without psychotic episodes. A simple form of schizophrenia begins with the loss of previous motivations for life and interests, idle and meaningless behavior, and isolation from real events. It progresses slowly, and the negative manifestations of the disease gradually deepen: decreased activity, emotional flatness, poor speech and other means of communication (facial expressions, eye contact, gestures). Efficiency in study and work decreases until they stop completely. Hallucinations and delusions are absent or occupy a small place in the picture of the disease.
• Paranoid form is the most common form; The clinical picture is dominated by hallucinatory-paranoid syndrome and mental automatism syndrome. The paranoid form is characterized by the predominance in the picture of the disease of delusional and hallucinatory disorders, forming paranoid, paranoid syndromes, Kandinsky-Clerambault syndrome of mental automatism and paraphrenic syndrome. At first, they note a tendency towards systematization of nonsense, but later it becomes more and more fragmentary, absurd and fantastic. As the disease progresses, negative symptoms appear and intensify, creating a picture of an emotional-volitional defect.
• The hebephrenic form is characterized by the predominance of hebephrenic syndrome. This form differs from the simple one in the patients’ greater mobility, fussiness with a touch of foolishness and mannerisms, and instability of mood is characteristic. Patients are verbose, prone to reasoning, stereotypical statements, their thinking is poor and monotonous. Hallucinatory and delusional experiences are fragmentary and striking in their absurdity. According to E. Kraepelin, only 8% of patients experience favorable remissions, but in general the course of the disease is characterized by malignancy.
• The catatonic form is characterized by the predominance of the catatonic syndrome in the clinical picture of the disease. This form manifests itself as a catatonic stupor or agitation. These two states can alternate with each other. Catatonic disorders are usually combined with hallucinatory-delusional syndrome, and in the case of an acute paroxysmal course of the disease - with oneiric syndrome.
Flow and types of flow
There are continuous and paroxysmal-progressive types of schizophrenia. Before the advent of ICD-10, there were two more types of progression in Russian psychiatry: recurrent and sluggish. In ICD-10 (as well as in DSM-IV), there are no diagnoses of recurrent schizophrenia and sluggish schizophrenia. Currently, these disorders are identified as separate nosological units - schizoaffective disorder and schizotypal disorder, respectively (see Schizoaffective disorder, Schizotypal disorder).
• The continuous type of course is characterized by the absence of clear remissions during treatment and the steady progression of negative symptoms. Spontaneous (without treatment) remissions are not observed with this type of course. Subsequently, the severity of productive symptoms decreases, while negative symptoms become more and more pronounced, and in the absence of treatment effect, it comes to the complete disappearance of positive symptoms and pronounced negative symptoms. A continuous type of course is observed in all forms of schizophrenia, but it is exceptional for simple and hebephrenic forms.
• The paroxysmal-progressive type of course is characterized by complete remissions between attacks of the disease against the background of progression of negative symptoms. This type of schizophrenia in adulthood is the most common (according to various authors, it is observed in 54–72% of patients). Attacks vary in severity, clinical manifestations and duration. The appearance of delusions and hallucinations is preceded by a period of severe affective disorders - depressive or manic, often replacing each other. Mood fluctuations are reflected in the content of hallucinations and delusions. With each subsequent attack, the intervals between attacks become shorter and the negative symptoms worsen. During the period of incomplete remission, patients retain anxiety, suspicion, a tendency to delusionally interpret any actions of others, and hallucinations occasionally occur. Particularly characteristic are persistent subdepressive states with decreased activity and a hypochondriacal orientation of experiences.
Research methods . There is no effective test to diagnose schizophrenia. All studies are aimed mainly at excluding an organic factor that could cause the disorder • Laboratory research methods: •• CBC and OAM •• biochemical blood test •• study of thyroid function •• blood test for vitamin B12 and folic acid •• analysis blood for the content of heavy metals, drugs, psychoactive drugs, alcohol • Special methods •• CT and MRI: exclude intracranial hypertension, brain tumors •• EEG: exclude temporal lobe epilepsy • Psychological methods (personality questionnaires, tests [for example, Rorschach tests, MMPI ]).
Differential diagnosis
• Psychotic disorders caused by somatic and neurological diseases. Symptoms similar to those of schizophrenia are observed in many neurological and somatic diseases. Mental disorders in these diseases usually appear at the onset of the disease and precede the development of other symptoms. Patients with neurological disorders tend to be more critical of their illness and more concerned about the onset of symptoms of mental illness than those with schizophrenia. When evaluating a patient with psychotic symptoms, an organic etiological factor is always excluded, especially if the patient exhibits unusual or rare symptoms. The possibility of superimposed organic disease should always be kept in mind, especially when a patient with schizophrenia has been in remission for a long time or when the quality of symptoms changes.
• Simulation. Schizophrenic symptoms can be invented by the patient or for the purpose of obtaining “secondary benefit” (simulation). Schizophrenia can be simulated, because The diagnosis is largely based on the patient's statements. Patients who actually suffer from schizophrenia sometimes make false complaints about their supposed symptoms in order to receive some benefits (for example, a transfer from disability group 3 to disability group 2).
• Mood disorder. Psychotic symptoms are observed in both manic and depressive states. If a mood disorder is accompanied by hallucinations and delusions, their development occurs after pathological changes in mood occur, and they are not stable.
• Schizoaffective disorder. In some patients, symptoms of mood disorders and symptoms of schizophrenia develop simultaneously and are expressed equally; Therefore, it is extremely difficult to determine which disorder is primary - schizophrenia or a mood disorder. In these cases, a diagnosis of schizoaffective disorder is made.
• Chronic delusional disorder. The diagnosis of delusional disorder is valid for systematized delusions of non-bizarre content, lasting at least 6 months, with the preservation of normal, relatively high personality functioning without pronounced hallucinations, mood disorders and the absence of negative symptoms. The disorder occurs in adulthood and old age.
• Personality disorders. Personality disorders can be combined with manifestations characteristic of schizophrenia. Personality disorders are stable characteristics that determine behavior; the time of their appearance is more difficult to determine than the moment of onset of schizophrenia. As a rule, there are no psychotic symptoms, and if they are present, they are transient and unexpressed.
• Reactive psychosis (brief psychotic disorder). Symptoms last less than 1 month and occur after a clearly defined stressful situation.
TREATMENT
Social and psychological support in combination with drug therapy can reduce the frequency of exacerbations by 25–30% compared to the results of treatment with antipsychotics alone. Psychotherapy for schizophrenia is ineffective, so this treatment method is rarely used.
The nature of the disease is explained to the patient, they are reassured, and their problems are discussed with him. They try to form an adequate attitude towards the disease and treatment in the patient, and the skills to timely recognize signs of an impending relapse. An excessive emotional reaction of the patient’s relatives to his illness leads to frequent stressful situations in the family and provokes exacerbations of the disease. Therefore, the patient’s relatives must be explained the nature of the disease, treatment methods and side effects (the side effects of antipsychotics often frighten relatives).
Basic principles of drug therapy
• Drugs, doses, and duration of treatment are selected individually, strictly according to indications, depending on the symptoms, severity of the disorder and stage of the disease.
• Preference should be given to a drug that has previously been effective in a given patient.
• Treatment usually begins with small doses of drugs, gradually increasing them until the optimal effect is obtained. In case of acute development of an attack with severe psychomotor agitation, the drug is administered parenterally; if necessary, injections are repeated until the excitement is completely relieved, and subsequently the treatment method is determined by the dynamics of the psychopathological syndrome.
• The most common mistake is prescribing more antipsychotics to patients than necessary. Studies have shown that smaller amounts of antipsychotics usually produce the same effect. When a clinic increases a patient’s dose of antipsychotic medications every day, creating the impression that this is intensifying treatment and reducing psychotic symptoms, in fact, this effect depends only on the duration of exposure to the drug. Long-term administration of antipsychotics in large doses often leads to the development of side effects.
• Subjective severe sensations after the first dose of the drug (usually associated with side effects) increase the risk of a negative treatment outcome and patient evasion from treatment. In such cases, you need to think about changing the drug.
• The duration of treatment is 4–6 weeks, then, if there is no effect, the treatment regimen is changed.
• When incomplete and unstable remission occurs, the dose of drugs is reduced to a level that ensures the maintenance of remission, but does not cause depression of mental activity and pronounced side effects. This maintenance therapy is prescribed for a long time on an outpatient basis.
Basic drugs
Neuroleptics - chlorpromazine, levomepromazine, clozapine, haloperidol, trifluoperazine, flupentixol, pipothiazine, zuclopenthixol, sulpiride, quetiapine, risperidone, olanzapine.
Antidepressants and tranquilizers are prescribed for depression and anxiety, respectively. When the depressive effect is combined with anxiety and motor restlessness, antidepressants with a sedative effect, such as amitriptyline, are used. For depression with lethargy and decreased behavioral energy, antidepressants with a stimulating effect, such as imipramine, or without a sedative effect, such as fluoxetine, paroxetine, citalopram, are used. Tranquilizers (eg, diazepam, bromodihydrochlorophenylbenzodiazepine) are used short-term to treat anxiety.
Complications during treatment with neuroleptics
Long-term therapy with antipsychotics can lead to the development of persistent complications. Therefore, it is important to avoid unnecessary treatment by varying doses depending on the patient's condition. Anticholinergic drugs prescribed to relieve adverse extrapyramidal symptoms, with long-term continuous use, increase the risk of tardive dyskinesia. Therefore, anticholinergic drugs not used constantly and for prophylactic purposes , but are prescribed only in case of adverse extrapyramidal symptoms.
• Akineto-hypertensive syndrome •• Clinical picture: mask-like face, rare blinking, stiffness of movements •• Treatment: trihexyphenidyl, biperiden.
• Hyperkinetic-hypertensive syndrome •• Clinical picture: akathisia (restlessness, feeling of restlessness in the legs), tasykinesia (restlessness, desire to constantly move, change position), hyperkinesis (choreiform, athetoid, oral) •• Treatment: trihexyphenidyl, biperiden.
• Dyskinetic syndrome •• Clinical picture: oral dyskinesia (tension of the masticatory, swallowing, tongue muscles, an irresistible desire to stick out the tongue), oculogyric crises (painful rolling of the eyes) •• Treatment: trihexyphenidyl (6–12 mg/day), 20% caffeine solution 2 ml s.c., chlorpromazine 25–50 mg i.m.
• Chronic dyskinetic syndrome •• Clinical picture: hypokinesia, increased muscle tone, hypomimia in combination with local hyperkinesis (complex oral automatisms, tics), decreased motivation and activity, acairia (intrusiveness), emotional instability •• Treatment: nootropics (piracetam 1200– 2400 mg/day for 2–3 months), multivitamins, tranquilizers.
• Malignant neuroleptic syndrome •• Clinical picture: dry skin, acrocyanosis, sebaceous hyperemic face, forced posture - on the back, oliguria, increased blood clotting time, increased residual nitrogen in the blood, renal failure, decreased blood pressure, increased body temperature •• Treatment: infusion therapy (reopolyglucin, hemodez, crystalloids), parenteral nutrition (proteins, carbohydrates).
• Intoxication delirium develops more often in men over 40 years of age (with a combination of chlorpromazine, haloperidol, amitriptyline. Treatment is detoxification.
Prognosis for 20 years: recovery - 25%, improvement - 30%, care and/or hospitalization required - 20% • 50% of patients with schizophrenia attempt suicide (15% with a fatal outcome) • The older the age of onset, the more favorable the prognosis • The more pronounced the affective component of the disorder, the more acute and shorter the attack, the better it responds to treatment, and the greater the chance of achieving complete and sustainable remission.
Synonyms . Bleuler's disease, Dementia praecox, Discordant psychosis, Dementia praecox
ICD-10 • F20 Schizophrenia
Notes.
• pfropfschizophrenia (from German Pfropfung - vaccination) - schizophrenia developing in an oligophrenic "oligoschizophrenia" pfropfhebephrenia "vaccinated schizophrenia
• Huber's senesthetic schizophrenia - schizophrenia with a predominance of senestopathies in the form of burning sensations, constriction, tearing, turning over, etc.
• schizophrenia-like psychosis (pseudoschizophrenia) is a psychosis similar or identical in clinical picture to schizophrenia.
• schizophrenia-like syndrome is the general name for psychopathological syndromes similar in manifestations to schizophrenia, but occurring in other psychoses.
• nuclear schizophrenia (galloping) - rapid development of emotional devastation with the disintegration of pre-existing positive symptoms (end state).
Suicidal behavior in patients with schizophrenia
The term “suicidal behavior” refers to a conscious action that is aimed at voluntarily taking one’s own life. In schizophrenia, we can talk about it only if the suicide is aware of his actions (is not in a psychotic state, and also does not have pronounced personality defects). In other cases, such behavior is considered auto-aggressive.
According to statistics, about half of patients suffering from schizophrenia attempted to commit suicide over a twenty-year period of illness. Of these, 10% were completed. Suicidal behavior is a direct indication for seeking consultation with a psychiatrist. And the best option is to hospitalize the suicidal person in a psychiatric hospital.
Treatment of schizophrenia
The vast majority of people suffering from schizophrenia need qualified help in a psychiatric hospital. Hospitalization allows for constant monitoring of the patient, detecting minimal changes in his condition. At the same time, the clinical manifestations of the disease are detailed, additional studies are carried out, and psychological tests are performed.
Despite the achievements of modern medicine, methods that would completely cure schizophrenia are still unknown. However, the methods of therapy used today can significantly alleviate the patient’s condition, reduce the number of relapses of the disease and almost completely restore his social and daily functioning. a major role in the treatment of schizophrenia . For this purpose, three groups of psychotropic drugs are used: antipsychotics, antidepressants and tranquilizers. They are used for a long time (from a week to several years, up to lifelong use). It is important to remember that the earlier treatment for schizophrenia is started, the better the prognosis awaits the patient.
Do I have schizophrenia?
It is possible to distinguish an endogenous mental illness from a neurotic disorder only by consulting a psychiatrist. Moreover, a diagnosis of schizophrenia requires long-term hospitalization in a psychiatric hospital, where the person will be observed by a whole group of specialists: psychiatrists, psychotherapists and clinical psychologists. If necessary, for differential diagnosis, a consultation with a neurologist and other somatic doctors, as well as additional hardware and laboratory diagnostics, can be prescribed. It is impossible to make a diagnosis in absentia or via the Internet, much less prescribe treatment. If you are concerned about mental discomfort, be sure to visit the office of a psychiatrist-psychotherapist or contact your relatives and loved ones who will help you contact a specialist and get the necessary help.
Prognosis if there is schizophrenia
Psychosis is always a serious mental illness, noticeable to others. With psychosis, a person is often not critical of his condition and has poor understanding of himself as a person, the surrounding space and time. He seems to be immersed in his imaginary world, does not understand where he is, has a poor idea of what day and time of day it is, and has a poor ability to differentiate and describe what is happening to him now. It is difficult to establish contact with such a person. Schizophrenia and some other endogenous mental illnesses lead to the destruction of the usual picture of the world and a personality defect, which makes a disabled person incapable of working or starting a family.
Neurosis always occurs with continued criticism of one’s condition. A person understands what he is suffering from and can clearly describe his mental and physical discomfort. The connection with people and the outside world is maintained. Often loved ones may not even know what is going on in the soul of a given person. Despite severe suffering, such patients retain the ability to perform productive activities, although this is difficult for them. Neuroses never lead a person to disability or personality destruction.
Features of treatment - if I have schizophrenia
A state of acute or reactive psychosis requires immediate hospitalization in the acute department of a psychiatric hospital. Such a patient poses a danger both to himself and to the people around him. He requires 24-hour supervision by medical staff. The main treatment is medication. Psychotherapy and rehabilitation are auxiliary in nature. Schizophrenia and other chronic mental illnesses are treated with long-term or lifelong use of special medications. A psychiatrist is treating a patient with psychosis.
The main treatment for neurosis is psychotherapy, where a person develops the adult part of his personality, learns to react productively to any difficulties and manage his life. Sometimes drug therapy is prescribed to relieve severe anxiety, stabilize mood, and combat insomnia. This is usually necessary in the early stages of treating neurosis. Therapy for neurotic disorders takes place on an outpatient basis and only in rare cases does it require the patient to be admitted to a neurosis clinic or undergo treatment at a day hospital. A patient with neurosis should first of all seek advice from a psychotherapist.
Treatment with psychotropic drugs
Antipsychotic therapy is indicated in the presence of an acute condition. The choice of drug depends on the clinical symptoms of the attack (exacerbation). In case of dominance of psychomotor agitation, hostility, aggressiveness, antipsychotics are used, which have a predominant sedative effect (tizercin, chlorpromazine, chlorprothixene). If hallucinatory-paranoid symptoms predominate, “powerful” typical antipsychotics are prescribed that can fight them (haloperidol, trifluoperazine). The polymorphism of clinical symptoms requires the use of typical antipsychotics that have a broad antipsychotic effect (mazeptil or piportil). Sluggish schizophrenia is treated with low or medium doses of antipsychotics and antidepressants. In the case of sluggish schizophrenia, accompanied by phobias and obsessions, sedative tranquilizers (Relanium, phenazepam, alprazolam, lorazepam) are used.
Dealing with the side effects of antipsychotic medications
Long-term use of antipsychotics very often leads to drug intolerance. It manifests itself as side effects on the nervous system and the development of complications (tardive dyskinesia and neurolepsy). In such situations, antipsychotics are prescribed that do not cause or practically do not cause unwanted neurological symptoms (Leponex, Zyprexa, Rispolept). If dyskinesia occurs, antiparkinsonian drugs (akineton, napam, cyclodol, etc.) are included in the therapy. If depressive disorders appear, antidepressants are used (rexetine, anafranil, ludiomil, amitriptyline, etc.). You should know that all prescriptions are made and adjusted by a doctor. Spontaneous discontinuation of medications is prohibited. This is fraught with a high risk of relapse.
Electroencephalography
The bioelectrical activity of the brain, recorded using an electroencephalogram (EEG), is an indirect indicator of its functional activity.
In particular, electrical impulses detected during EEG mapping can say a lot about the nature of information processing and storage. Modern mapping methods make it possible to isolate individual rhythms, study their power, synchronization features and localization in various areas of the brain. Synchronization in this case reflects the way in which the properties of an object are linked into a consciously perceived image. It also characterizes functional integration between brain regions. Modern EEG studies suggest that its features are primarily due to synchronized, postsynaptic activity of the cerebral cortex and thus reflect the postsynaptic effects of cortically released neurotransmitters.
Typically, the EEG of a patient with schizophrenia reflects increased activity of brain stem structures, diffuse changes in the activity of neurons in his cortex (Kamenskaya V.M., 1966).
Bioelectric activity of the brain in schizophrenia
- Weakly specific diffuse nature of changes
- Increased activity of stem structures
- Reduced alpha index
- Increased synchronization of delta and theta activity in the frontal and temporal areas of the cortex, especially in the paranoid form of schizophrenia
- An increase in the beta index in the left temporo-parietal region with pronounced positive symptoms and a decrease in the beta index in the right hemisphere with persistent negative symptoms
- Shift of the asymmetry index towards the left hemisphere in depressive-delusional syndrome and towards the right hemisphere in manic-delusional syndrome and oneiric catatonia
- The appearance of a paradoxical reaction - an increase in the beta rhythm in response to functional loads in continuous schizophrenia
Often, changes in the EEG of patients with schizophrenia resemble changes in the bioelectrical activity of people who have been abusing certain drugs for a long time, for example, LSD.
| | Neurophysiological methods play an important role in the diagnosis of schizophrenia |
A study of the bioelectric activity of the brain of patients with schizophrenia at rest reveals various, but weakly specific deviations from the norm, which, first of all, indicate disintegration of the activity of the cerebral cortex.
Changes in the bioelectrical activity of the brain in schizophrenia include: a decrease in the alpha activity index, increased synchronization of delta and theta activity, especially in the frontal and temporal regions of the cerebral cortex, an increase in the amount of beta activity in the left temporo-parietal region.
These data are partly correlated with a decrease in regional blood flow in the frontal regions of the brain, which suggests a weakening of the functional activity of the frontal cortex in schizophrenia or the “hypofrontality” phenomenon.
At the same time, due to the large number of artifacts in the electroencephalogram of patients with schizophrenia (eye movements, muscle activity, etc.), changes in the bioelectrical activity of the brain revealed in this study should be interpreted carefully.
At one time A.A. Vishnevskaya and V.M. Kamenskaya (1972) noted the dependence of the characteristics of the electroencephalogram on the type of course of schizophrenia. In adolescents with a slow, continuous type of schizophrenia, an alpha rhythm was recorded that was changed in shape and duration. Non-rhythmic slow waves with a length of 3-5 Hz and an amplitude of 30 to 60 µV were observed. Slow activity was noted diffusely, but its greatest severity was recorded in the parietal and frontoparietal leads. Changes in bioelectrical activity during the continuous type of schizophrenia were persistent. During the acute onset of the disease, as a rule, the alpha rhythm was absent. Against this background, slow waves of low amplitude (20-30 µV) were recorded. Some patients experienced rare volleys of paroxysmal activity in the form of slow waves with an amplitude of 50-100 µV. After active therapy, these changes in brain activity quickly disappeared, and when performing functional tests, clear reactions of a paradoxical type were recorded.
According to N.V. Filippova and V.B. Villanova (2006), common to patients with the paranoid form of schizophrenia can be considered an increase in the background EEG, compared with the “norm,” in the spectral power of the delta and theta ranges and a decrease in the alpha rhythm, expressed to varying degrees. These changes may reflect a disturbance in the functional activity of the cortical-subcortical brain systems associated with the generation of the alpha rhythm. Beta activity is increased in patients with schizophrenia with positive symptoms (especially in the left hemisphere) and reduced when negative symptoms predominate (especially in the right hemisphere). The asymmetry index (AI) in patients with depressive-delusional symptoms shifts towards the left hemisphere, which suggests its hyperactivity. In patients with elevated background mood and in patients with oneiric catatonia, on the contrary, the IA shifts to the right. During therapy, the AI value approaches the “norm”. In continuous schizophrenia, IA is significantly different from the norm, manifested by a decrease in bioelectrical activity in the alpha range and the appearance of a paradoxical reaction - an increase in the beta rhythm in response to functional loads. Moreover, such changes are quite persistent.
Advice for relatives of someone with schizophrenia
Schizophrenia is a serious illness, both for the person himself and for his close circle. However, if a person is not able to understand that he is sick, the family is simply obliged to recognize the disease and seek help from a psychiatrist. It's time to dispel existing stereotypes that it is impossible to help a person with schizophrenia. Maybe. With properly selected therapy, long-term, high-quality remissions are achieved with full restoration of ability to work over a long period of time. The main thing is to recognize the disease in time and begin treatment. If this is not done, the person will usually face emergency hospitalization in a state of psychosis. Don't wait until the worst happens to take action. Relatives are the only people who can change the life of a person with schizophrenia for the better. The quality of life of patients suffering from this disease largely depends on their support and their participation in the recovery process. If you suspect someone close to you has schizophrenia, contact a psychiatrist immediately.
We also recommend reading the article about low-grade schizophrenia.
First stage of schizophrenia: mastery
From the familiar, predictable real world, the patient moves into a distorted, phantasmagoric world of visions, hallucinations, unusual colors and unusual proportions. Not only is his world changing, he himself is changing. With the rapid course of schizophrenia, in one’s own eyes a person becomes a hero or an outcast, a savior of the universe or a victim of the universe.
If changes occur gradually, the first stage of schizophrenia may be dominated by anxiety, confusion and fear: something wrong is clearly happening with the world around us, people’s motives are not clear, but they do not promise anything good - you need to prepare either for defense or for flight.
The first stage of schizophrenia can be called a period of discoveries and insights. The patient seems to see the essence of things and the true meaning of events. There is no place for routine and calm in this phase.
The discovery of a new world can be wonderful (for example, with a feeling of omnipotence) or terrible (with the realization of the insidious plans of enemies who allegedly poison the patient, kill him with rays or read his thoughts), but it is impossible to calmly experience the changes.
It happens that after experiencing a bright, stormy phase of mastery, the patient completely returns to normal life. And with an unfavorable course of schizophrenia, short, almost imperceptible periods of mastery and adaptation are quickly replaced by a long phase of degradation.
