In psychiatry, people often wonder how to distinguish depression from schizophrenia. These psychological disorders are similar, in addition, there are cases when they are present in a person at the same time.
For example, depression in schizophrenia is in some cases an integral symptom of the disease.
But depression can also occur on its own.
Cardinal differences between depression and schizophrenia
Both depression and schizophrenia are psychosocial disorders that contribute to a person's withdrawal from society and the world around them.
Schizophrenics are most likely to exhibit abnormal behavior social behavior, may not perceive reality due to strong hallucinations. Along with hallucinations, patients have a disorder thought process, catatonia and paranoia.
Depression is long lasting psychological disorder, main symptom which is stable Bad mood. In addition, with depression, a person may feel tired, anxious, guilty, helpless, and sad.
Symptoms fundamentally distinguish depression from schizophrenia. The key difference between these 2 concepts is that with depression there is necessarily sadness, gloominess, bad mood and unnatural pessimism, while with schizophrenia such signs may not be present. The patient may not have feelings of sadness, depression and pessimism. These are the defining signs of depression.
In addition, schizophrenia is a broader concept in relation to depression. Depression may be a symptom of this disease.
Thus, to determine which mental disorder is present in the patient: depression or schizophrenia, you need to carefully study the symptoms.
Depression in schizophrenia and depressive schizophrenia
According to research, schizophrenics are more likely to suffer from depression than others. Most patients experience sadness and a feeling of depression. Depressive symptoms equally common in men and women.
If depression can stop during schizophrenia, then in the depressive form of schizophrenia it is the determining factor.
There are a number of factors that can contribute to the occurrence of the depressive form of this disease:
- Diseases. Depressive symptoms may be caused by certain physical conditions such as disorders thyroid gland or anemia.
- By-effect. Side effects of medications can also cause severe mental disorders. This applies to antibiotics, antidepressants, and antiallergic drugs.
- Schizoaffective disorder. With this type of disorder, depression will manifest itself along with hallucinations and paranoia.
- Drugs. Drugs, including cocaine and cannabis, will cause feelings of depression, sometimes lasting for several days after taking them.
- Loneliness. 3/4 of people with schizophrenia experience loneliness. The reasons for loneliness may be due to psychological factors. For example, this may be due to a lack of communication skills or low self-esteem. For some people, loneliness can become chronic problem. It can lead to self-destruction and suicide, and negatively affect the personal qualities of perseverance and will.
- Despair and disappointment. Schizophrenia often manifests itself in adolescence. At this time, teenagers are psychologically vulnerable. Disappointment from unfulfilled hopes and strong emotions experienced provoke the emergence of mental problems.
- Life shocks. Life events such as bereavement can lead to severe stress, psychosis, and depressive schizophrenia. Increased sensitivity The stress experienced can cause people to completely isolate themselves from society.
Depression and schizophrenia - potentially dangerous disorders, so you need to identify their symptoms in time.
Symptoms to see a doctor
With different forms of schizophrenia, symptoms may vary, but it is better to consult a doctor immediately after identifying the following symptoms:
- Weight loss.
- Feeling empty.
- Lack of motivation and energy.
- Slowness of speech and movements.
- Insistent thoughts of death and suicide.
- Sleep disturbance.
- Great nervousness and anxiety.
- Constant fatigue.
- Feelings of worthlessness and guilt.
- Constant feeling of sadness.
- Lack of interest and pleasure in life.
- Poor concentration.
- Low self-confidence.
- Pessimism.
- Loss of appetite.
- Loss of libido.
- Hallucinations.
- Paranoia.
When talking with a patient, the doctor should find out the following:
- How does a person feel about personal hygiene?
- Is he excited or confused?
- Does his mood match his facial expression?
- Is the patient willing to maintain eye contact?
- How fast is his movement and speech speed?
- Does he feel depressed or, on the contrary, does he seem nervous?
- Does he have a feeling self-esteem?
- How does he feel in the company of people he doesn’t know?
- Does the patient remember his name?
- Can he recall in his memory what happened to him throughout the day or week?
- Does the patient have paranoia?
- Has he ever had suicidal thoughts?
- Has the patient used alcohol or drugs?
- Does he have a desire to withdraw from society?
These questions during the initial conversation will help establish the presence and severity of a mental disorder. If there are reasons for concern, to confirm the diagnosis, the doctor may prescribe an MRI, conduct a neurotest, duplex scanning.
People with schizophrenia are 13 times more likely to commit suicide than simple people. They may abuse alcohol or take drugs.
Remember that contacting a doctor when symptoms of mental disorders appear can not only protect a person from health problems, but in some cases, save life.
Despite the widespread prevalence of depression, diagnosis of this disorder mental health may be difficult. For example, it is known that in schizophrenia early stage The disease presents the same symptoms that are characteristic of depression. The picture of depression itself in this case may be long-lasting and clearly defined, or it may proceed implicitly, disguised. Therefore, only a specialist knows how to distinguish depression from schizophrenia. In addition, in patients with schizophrenia, depression is a kind of precursor to the occurrence of hallucinations and delusions. At the same time, it is important to diagnose schizophrenia earlier, since after a certain time delusional states become stable and treatment becomes more complicated.
As you know, the onset of schizophrenia is characterized by a large number of emotions, which are very diverse. This can be expressed in varying degrees experiences that relate to the patient experiencing a change in perception environment. Very often a person falls into depressive state, which is a certain obstacle to establishing accurate diagnosis. In addition, the patient may experience causeless euphoria and periodically experience a state of mental well-being. As for depression, in schizophrenia it quickly disappears, since the circumstances outside world change, the patient tries in vain to adapt to new conditions.
In order to correctly and timely differentiate depression from schizophrenia, a thorough study of these diseases is necessary. In particular, with the development of schizophrenia, the patient suffers from many emotional experiences who are unmotivated. A person is haunted by a feeling of internal unreasonable fear, a feeling of guilt, and all these factors should be taken into account not individually, but comprehensively. For example, in schizophrenia, particularly implausible delusions with absurd content are observed. The person is also haunted by hallucinations various types, but more often they are auditory, when a person hears voices.
Features of depression
The word depression is translated from Latin as “to suppress”; this mental disorder is characterized by the presence of a depressive triad. In particular, mood decreases, the ability to rejoice is largely lost, and thinking is impaired to a certain extent. Depression makes a person think negatively, he looks at the future pessimistically, it is noted motor retardation. Doctors know how to distinguish depression from schizophrenia, since these diseases have been well studied by specialists, and there are the most effective methods treatment. As for people suffering from depression, their self-esteem is extremely low. There is a loss of interest in ordinary activities that previously seemed necessary and exciting.
In this regard, such signs can really be mistaken for the initial stage of schizophrenia, so a very careful approach to diagnosis is required. Depression like mental disorder, represents a disorder of affect. If the disease lasts a long time, for example, more than six months, then doctors consider this state not like a disorder, but like serious illness psyche. Unlike schizophrenia, depression is easy to treat and there are no difficulties with it. In addition, on full recovery can be counted on in about eighty percent of cases. In the same time, medical statistics confirms that in our time, among other mental disorders, depression is most often diagnosed.
This disease is susceptible great amount people, in percentage terms it is ten percent of the population. The age category of people suffering from this disease is usually from forty years. In addition, women suffer from depression more often, among total number two-thirds of them are sick. Significant problems arise if a person abuses alcohol during depression, and many people intensively use drugs that have a strong effect on the central nervous system. Many people suffering from depression try to distract themselves by devoting themselves completely to work, which is also not the best solution.
Diagnostics
To identify whether a patient is depressed, doctors often use special test, which is called the Zang scale. For more successful treatment depression must be diagnosed at the very beginning of its development. The same can be said about schizophrenia, as well as almost any disease. There are many difficulties with schizophrenia; they know how to distinguish depression from schizophrenia, so patients come to clinics from almost all over the world. Doctors note that in in this case, a special responsibility lies with the patient’s relatives, because they are the first to notice that the person is not just in a bad mood and depression, but something more serious that requires immediate medical attention.
It should be noted that it is not so easy to recognize schizophrenia on your own, because it is necessary to distinguish it from depression and a number of other mental disorders. For example, depression can occur against the background of a traumatic situation, and in this case, the main symptoms are a reflection of the nature and characteristics of the difficult event suffered. Of course, compared to schizophrenia, depression can be cured without much difficulty. If the patient develops schizophrenia, then a completely different approach is required.
Sometimes the diagnosis of schizophrenia is particularly difficult, and from the onset of the disease to the final diagnosis is sometimes required long time. Of course, this cannot but affect healing process started late. Therefore, it is recommended to contact experienced specialists with significant experience in this field.
Depression and schizophrenia may have similar symptoms - depressed mood, feelings of guilt, a person’s “obsession” with inadequate ideas (that he is seriously ill or has not succeeded in any way in life). In both cases, a person may not get out of bed for days or weeks, abandon usual activities, stop communicating with loved ones, and even try to commit suicide.
Only a psychotherapist can distinguish between depression and schizophrenia. It is possible that a person suffers from both (depressive schizophrenia), so you should not postpone a visit to a specialist.
Depression can also occur after schizophrenia - due to exhaustion of the body and side effects therapy. For post-schizophrenic depression (depression after schizophrenia), the attending physician must adjust the therapy - change the combination of medications, select adequate dosages. You should not self-medicate and put off seeing a doctor, because in this condition a person has a high risk of suicide.
Depression in schizophrenia
One in four people with schizophrenia experiences depression. Manifestations of depression dominate, while signs of mental illness are present slightly, often with negative symptoms(lack of will, emotional coldness) than with positive ones ( crazy ideas, hallucinations).
Depression in schizophrenia is confirmed by symptoms that manifest themselves as follows:
- psychomotor retardation - a person does not get out of the inhibited state, is constantly in indifference (apathy) and does not want to do anything;
- gloom, melancholy, indifference to everything around - a person has no reaction to what is happening, he perceives both joyful and sad events with equal indifference.
- sleep disturbance and anxiety.
Can depression turn into schizophrenia?
It happens that prolonged depression gradually turns into schizophrenia. An experienced specialist will see signs of schizophrenia at the beginning - symptoms unusual for depression, changes in tests, insufficient effect of medications.
Special methods help diagnose the problem in a timely manner:
- Clinical and anamnestic examination- the psychiatrist questions the person and identifies symptoms (overt and hidden).
- Pathopsychological study - clinical psychologist identifies specific thinking disorders in a person.
- Modern laboratory and instrumental methods (Neurotest, Neurophysiological test system) - allow you to accurately, objectively confirm the diagnosis of “schizophrenia” and assess the severity of the disorder.
Clinical and anamnestic examination in psychiatry is considered the main diagnostic method. The psychiatrist talks with the patient, notes the features mental state, observes facial expressions, reactions to questions, intonation, notices what is not visible to a non-specialist. If necessary, the doctor prescribes additional tests.
How to distinguish depression from schizophrenia? Only a doctor can answer correctly.
Treatment depends on the severity of symptoms. Drug correction of symptoms is carried out:
- neuroleptics;
- antidepressants;
- tranquilizers;
- sedatives.
After the symptoms subside, the patient can begin psychotherapy, which is carried out by a professional psychotherapist. A person, with the help of a specialist, determines what led to the disease - stress, conflicts with loved ones, internal experiences. This way he can figure out at least part of the causes of the disease and increase the chances of a stable and long-term remission.
Types of schizophrenia are determined by the nature of symptoms and characteristics of the course. Manic schizophrenia is characterized by a number of specific manifestations - periods of severe depression are followed by periods of increased excitability and mania. The disease cannot be cured completely, however drug therapy in many cases it allows you to achieve long-term remission and live in society. At the same time, in case of schizophrenia, medications will have to be taken permanent basis, otherwise the disease will worsen, accompanied by severe symptoms.
The disease can occur in people of any gender
Schizophrenia is a severe mental disorder that changes the perception of reality. Despite the fact that the disease was first described more than a hundred years ago, doctors still cannot accurately determine the mechanisms of its development.
The disease can take various shapes, and manic schizophrenia is one of them. Moreover, doctors are still not sure whether this is directly related to the negative symptoms of schizophrenia, or whether the manic-depressive phases are secondary mental disorder against the background of this disease.
Today, schizophrenia is very common and is diagnosed in four out of a thousand people. This disease is one of the three diseases leading to early disability.
The problem with schizophrenia is the difficulty of treatment. There is no universal drug for this disease, so patients have to find the optimal medicine for a long time. Some drugs cause severe side effects, while others, less dangerous adverse reactions, may simply not be suitable for the patient.
The disease is equally common in women and men. At the same time, the symptoms cannot be accurately divided into purely feminine and purely masculine. As a rule, in women the disease first manifests itself in more late age, and the course of the disease is more favorable. In other words, by taking the right medications, it is possible to achieve a stable remission, in which the symptoms of the disease completely subside and do not affect the person’s quality of life. Despite the fact that in some patients, after treatment, the disease may not reappear at all throughout life (subject to constant supportive drug therapy), there is always a risk of exacerbation due to any traumatic factors.
Manic-depressive schizophrenia refers to a disorder of consciousness that occurs under the guise of manic-depressive psychosis. However, it is impossible to establish for sure whether psychosis is a consequence of schizophrenia or its main symptom.
This type of disease is characterized by obvious affective disorders. The condition is often mistaken for bipolar disorder, which can make diagnosis difficult. In general, the diseases are very similar, but with bipolar disorder Against the background of schizophrenia, there is a pronounced positive and negative symptoms underlying mental illness.
There is no diagnosis of manic schizophrenia in ICD-10. This disease is designated by two codes at once - F20 (schizophrenia) and F31 (bipolar affective disorder).
What is manic-depressive psychosis?
IN modern world pathology began to be diagnosed much more often than before
Manic-depressive psychosis is an independent disease, an outdated name for bipolar affective disorder. The word “bipolar” means that the symptoms appear in phases, changing to the opposite. In other words, the patient begins a phase of severe depression, which after some time is replaced by an acute manic phase.
Bipolar affective disorder should not be confused with manic-depressive schizophrenia. These are different mental illness, which can develop in parallel. In general, there is no official diagnosis of manic schizophrenia. Usually we are talking about schizophrenia aggravated by bipolar disorder. And talk specifically about manic schizophrenia is possible only if the patient first developed symptoms of schizophrenia, which was eventually joined by manic-depressive disorder.
Schizophrenia with manic symptoms is very similar to bipolar disorder in its symptoms, but differs in treatment methods. The patient's response to medications used for bipolar disorder is the main difference between manic schizophrenia and psychosis.
Depressive phase in schizophrenia
As already mentioned, manic schizophrenia, the symptoms of which resemble bipolar affective disorder, occurs in alternating phases.
The initial phase of this disease is most often depression. It develops rapidly, symptoms increase literally within a few days, progressing from light form depressive disorder to severe depression.
During the depressive phase of manic schizophrenia, the symptoms are the same in men and women.
With this disease, all the signs of the so-called “depressive triad” are observed:
- slowing down of speech and speed of thinking;
- motor retardation;
- flattened affect.
The patient shows low interest in surrounding events, demonstrates complete apathy and lack of interest. The term “flattened affect” refers to the weakness of emotional reactions, inhibited and feigned expression of emotions.
The patient's speech becomes lifeless and loses its emotional coloring. Patients tend to speak monotonously, try to answer in monosyllables, or completely ignore questions.
Motor retardation is manifested by a slowdown in the speed of reaction to stimuli, poor facial expressions and a slowdown in all movements in general.
The depressive phase is accompanied by the following symptoms:
- loss of appetite;
- tendency to self-examination;
- hypochondria;
- yearning;
- prolonged immobility, stupor;
- asthenia;
- thoughts about suicide.
This phase lasts a long time and has a negative impact on the overall psycho-emotional state patient. Often a patient with schizophrenia develops intrusive thoughts leading to suicide attempts.
Signs of a manic phase
A sharp change in mood, from one to another, is a typical symptomatic picture.
The second phase, manic, is the opposite of the depressive state and is manifested by the patient’s general agitation. Typical symptoms:
- emotional agitation;
- active facial expressions and gestures;
- fast speech with expressive coloring;
- feeling of spiritual uplift;
- elevated mood.
The manic phase against the background of schizophrenia is often manifested by a jump in ideas. This is a disorder in which thinking speeds up significantly, causing the person to jump abruptly from one idea to another. In manic schizophrenia, this is manifested by rapid speech with unfinished sentences. A person jumps from one topic to another. The jump of ideas is based on associative chains that may be incomprehensible to others if schizophrenia is aggravated by delusions. Quite often these associations are inconsistent, speech is greatly accelerated, but with due attention it becomes noticeable that a person’s thinking is coherent, it is simply not ordered.
Often, manic syndrome due to schizophrenia is manifested by illogical actions of the patient. The patient may wave his arms, speak very quickly, jumping from one thought to another, run and show impatience in other ways. This is due to general emotional arousal and an increase in the rate of flow mental processes in the central nervous system.
Other shapes and features
Signs of manic schizophrenia can be aggravated by hypochondria, delusions and hallucinations. At the same time, hypochondria and obsessions are more pronounced in the depressive phase, and delusions and hallucinations are more pronounced in the manic phase. In general, the specificity of symptoms depends on the severity of schizophrenia and additional factors.
There are some differences between the symptoms of manic schizophrenia in men and women. As a rule, in women the depressive phase occurs in a more severe form. In men, the manic phase is more pronounced, but the depressive state can be smoothed out. This is largely explained by the specifics of mental processes in men and women.
Course of psychosis
In case of illness, the state of depression can last up to six months
The phases replace one another, but differences in the course of the disease are possible in different people. As a rule, the depressive phase is more pronounced and can last up to several years. However, in most cases its duration is 4-6 months. The depressive phase is replaced by a manic phase, the duration of which is usually shorter, no more than 1-2 months. However, in men, the manic phase can be more pronounced and last longer.
Between phases there may be some period of normalization of the mental state, but in the case of schizophrenia with manic syndrome it is expressed very little. In general, the disease can occur in the following forms:
- unipolar form - there is only one phase, often manic, which is replaced by a short period of mental stability, and then repeats again;
- bipolar sequential form - typical sequential changes of depressive and manic state, clinical picture characteristic of bipolar affective disorder;
- bipolar inconsistent form - mania is replaced by a period peace of mind, and then mania occurs again, after which depression is possible, followed by a state of intermission;
- circular form - there is no state of rest between phases, so one phase immediately flows into another.
In the case of schizophrenia with manic syndrome, a unipolar form or a circular form of affective disorder is more often observed. Moreover, the latter option is more difficult, since it is more difficult to correct with medication.
Diagnostics
The diagnosis of “schizophrenia with manic syndrome” is made only if the patient has first been observed general symptoms schizophrenic disorder, against the background of which bipolar disorders developed affective disorders. Otherwise, a diagnosis of bipolar affective disorder will be made.
Here it is important to be able to distinguish the sequential change of phases with seasonal affective fluctuations characteristic of patients with schizophrenia. In general, the diagnosis is made based on medical history, conversation with the patient, and testing. In some cases, several months of observation are necessary to identify a specific form of schizophrenia.
Treatment principle
For each specific case, treatment is selected individually by a specialist.
The basis of treatment for the disease is drugs from the group of antipsychotics. They effectively relieve both the symptoms of schizophrenia and the manifestations of manic syndrome. However, in the depressive phase, these drugs are ineffective and can only worsen the patient’s well-being, so it is necessary complex therapy and correct dosage selection.
There is no universal drug that would suit all patients, so the treatment regimen is selected in several stages. All this time the patient must be under the supervision of a doctor. As a rule, they end up taking antipsychotics in the manic phase and tricyclic antidepressants in the depressive phase.
In the vast majority of cases, atypical antipsychotics are effective, but in some patients, taking these drugs can cause an exacerbation of the disease.
Target drug treatment– achieve stable remission, when the duration of the phases of mania and depression is reduced, and over time such symptoms completely disappear. After the depressive state has been relieved, they switch to constant use of medications for schizophrenia. In this case, the patient should be regularly examined for timely detection of negative dynamics of treatment or the development of side effects.
Forecast
No doctor can accurately predict the further course of the disease. Some patients manage to achieve stable remission. In such cases, only a single manifestation of the disease is possible throughout life, without further relapses. After a long course of taking medications, a decision may be made to prescribe a small maintenance dose, which will reduce the risk of recurrence of the disease without side effects.
In some cases, drug therapy can only achieve a reduction in the duration of one or another phase.
Patients are advised to regularly visit their doctor in order to be able to promptly recognize an exacerbation of the disease. As a rule, supportive drug therapy is complemented by psychotherapy to improve the patient's socialization.
Please don't reject! All descriptions are important! Woman, 29 years old. This is not the first year I have been suffering from VSD with PA, before that I went to doctors as standard, everything was within the normal range. For the last two years I have been living abroad, I don’t work, I don’t have much desire to communicate, find new acquaintances, I’m worried that I don’t speak English well, so (or not that’s why) I’m not very proactive in finding a job. It is not possible to see a psychiatrist due to the high cost of treatment and the same language. I saw a neurologist; he suggested seasonal depression and sent me away with the advice to get distracted and do something useful and interesting. Since childhood, I was timid, but active, sociable, and an excellent student. My relationship with my mother is good, but she controls me and pushes me in every possible way. My dad died when I was a teenager from a heart attack, we didn’t live together, we weren’t close, but we communicated. Now she’s married, no children, the relationship and atmosphere at home are good, they recently moved on my initiative, everything suits me. I run a small business that brings in very little income. Actually, to the question. Started last year panic attacks with neurological symptoms (dizziness, blurred vision, uncoordination of movements, etc.), was examined, had an MRI, vascular ultrasound, EEG, went to Russia and here to see a Russian neurologist and cardiologist, the diagnosis was something VSD type, recommendations - to calm down, they prescribed Xanax, took half a tablet, didn’t think anything for two days, stopped drinking, then everything somehow returned to normal, I forgot about my condition and continued to live normally. This year I began to feel tired, scold myself for failures, focus on my shortcomings, thought that I needed to change, work on myself, but did nothing, everything remained at the level of plans, in general I am very demanding of myself and often feel guilty . In mid-January, a panic attack suddenly struck, with all the ensuing fears, diagnoses began through a search for symptoms, as always, but this time it was difficult to stop. The neuropathologist (the same as last time) once again sent for an MRI and denied the presence multiple sclerosis , which I was afraid of, while I was waiting for the results it was very bad, I could not sit still. At the same time, I took tests for hormones and vitamins, everything was normal. In addition to the old ones (headache, poor sleep - I wake up every hour, my whole body aches, my eyes are blurry, indigestion, tremors), this time I had new symptoms (or a new disorder), I read on the Internet that it is called derealization-depersonalization. Falling out of reality, the feeling that a familiar object is not familiar to me, that my hands are not my hands, that is, I understand with my mind that they are mine, but it doesn’t respond emotionally, the perception is somehow different, and so on. In general, I am very worried about emotional impoverishment, I don’t feel anything except anger at myself and a constant desire to cry, and I just can’t cry, I need a reason. I constantly listen to myself and look closely, my sense of smell and hearing are enhanced (it hurts when I hear loud sounds or voices), my eyes periodically have black or shiny stains (maybe these are beginning hallucinations?), I wake up at night and realize that I can’t collect my thoughts. a bunch, there are either so many of them that I can’t keep up with them, or an empty head, or an obsessive melody, in general, in the last week or two, I’ve been tormented by obsessive songs in my head, obsessive desires to find the cause of my conditions on the Internet and get rid of them. Memory, attentiveness suffer (narrowing of attention span, I can’t do two things at the same time, but I’m constantly trying, it seems that a lot of time has been lost and I need to make up for it), cognitive abilities (I constantly forget what a word is called, I confuse words, sometimes I write with errors, although I used to be very literate), most of all, of course, this condition worries me, the fear of not returning to that state of mind, fresh, clear, when it was better... The fear of not returning emotionally, the fear of schizophrenia (because the description of the symptoms is very suitable, and I read that in the initial stages of the disease, some patients retain criticism and may have panic attacks due to the realization that something is going wrong in their head). Thank you for your attention, for reading such a long and chaotic message, but I am in despair, very tired of this state, I am trying to do practices, reading books on how to get rid of neurosis, doing yoga with my husband, going for walks, taking language courses, a lot I communicate with old friends and my mother online (correspondence is easier than conversation). I hope for an answer, I understand that the diagnosis is not made online, but at least a guess: could it be schizophrenia or schizotypal disorder?
