Which form of schizophrenia is most difficult to recognize? Schizotypal disorder

The latent form of schizophrenia, the symptoms of which are usually mild, usually develops and proceeds slowly, which creates certain difficulties in diagnosing it. Classical science identifies a number of forms of schizophrenia depending on the predominance of a particular psychopathological syndrome. Thus, classical psychiatry identifies the following forms of the disease:

• simple;
• catatonic;
• hebephrenic;
• paranoid;
• circular.

These forms of the disease may also have Various types course depending on the intensity of psychopathological changes.

Peculiarities of using the concept “latent form of schizophrenia”

The term “latent form of schizophrenia” as such is absent in the current international classification of diseases (ICD-10), that is, such a diagnosis cannot be used medical specialist when diagnosing the disease. However, in different classifications the term “latent form of schizophrenia” is mentioned; in addition, this disease has the following name options:

• low-grade schizophrenia;
• schizotypal disorder;
• latent schizophrenia.

This state of affairs is due not so much to the difficulties of interpreting the concept as to the need for careful diagnosis and the small number of signs of the disease.

The latent form of schizophrenia is characterized by very weak progression of the disease and slow pathological changes in the patient’s personality. As for the signs of the disease, as noted earlier, this form of schizophrenia has a limited number of specific symptoms.

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Symptoms of a latent form of schizophrenia

This form of the disease is characterized by a minimal set of symptoms and their weak degree expressiveness. So, characteristic features The hidden course of schizophrenia is as follows:

• emotional disorders;
• split mental processes;
• autism;
• absence of productive symptoms (hallucinations, delusions).

Since the so-called latent forms of schizophrenia are slow and develop gradually, this may be the beginning of a simple or paranoid form of the disease. Of course, only a psychotherapist should make a diagnosis for any mental disorder. Self-diagnosis in in this case unacceptable due to the weak intensity of symptoms.

The main features of these signs in the latent form of schizophrenia are their weak expression and erasure, which greatly complicates the diagnosis of the disease.

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Characteristics of symptoms

As mentioned above, emotional disorders are one of the main symptoms of a latent form of schizophrenia. These disorders are apathetic in nature and are characterized by slow fading and dimming of emotions. A person suffering from schizophrenia gradually becomes cold, alienated, callous, and incapable of empathy. All his emotions and feelings lose their brightness and natural strength, become amorphous and monotonous. Sometimes paradoxical emotional reactions arise, which subsequently begin to increasingly dominate the patient’s emotional spectrum. Such apathetic disorders are necessarily accompanied by a decrease in will, initiative, inactive indifference, lack of meaning in life and loss of life goals. However, at the same time, certain normal emotional manifestations, which usually arise due to some minor life events.

Except emotional disorders, the next main symptom of the latent form of schizophrenia is splitting. This pathological symptom characterized by the following manifestations. First of all, the patient experiences a lack of unity of mental processes, which leads to a loss of semantic connections of feelings, thoughts and actions. In the patient’s behavior and statements, this manifests itself as the coexistence of the paradoxical, absurd with the real, life-like. In addition, the patient experiences a loss of life goals and a predominance of paradoxical thoughts and ideas in his worldview. Thus, real life seems to be removed, and the main place in the consciousness of the sufferer hidden form schizophrenia is occupied with fantastic and absurd conclusions. Combinations of thoughts of completely opposite content are not uncommon. The following phenomena are also observed:

• discrepancy between emotional and facial reactions and statements;
• influxes of thoughts;
• delayed thinking;
• distortion of the experience of self-worth;
• speech disruption;
• distortion of the meaning of words and concepts;
• lack of arbitrariness of motor acts.

In addition to clefting, patients also exhibit symptoms of autism. varying degrees intensity. As a rule, it is expressed in a lack of desire for activity, for communication with others, for knowledge of the world around us. Wherein life position The patient is limited only to his inner world, and contact with the doctor becomes formal, superficial. The severity of autism depends on the intensity of symptoms such as dissociation and emotional disturbances.

Moreover, it must be said that characteristic features latent disease are the absence of productive symptoms and weak severity of general symptoms.

Until now, scientists cannot come to a consensus about what schizophrenia is, and some extremists in psychology propose to consider it not as a disease, but as a different way of perceiving reality. Due to these disagreements, the classification of forms of the disease is extremely difficult. However, today it is generally accepted that there are four main forms of schizophrenia: simple, paranoid (delusional), hebephrenic (disorganized) and catatonic.

Paranoid form of schizophrenia

The most common form, it is diagnosed in about 70% of all patients with schizophrenia. The word "paranoia" can be translated from Greek as "contrary to meaning." This is understandable, because the central symptom in this case is delusion - an unfounded judgment that cannot be corrected. Delusions of persecution are the most common, much less common are jealousy, grandeur, falling in love, etc. Examples of delusions and other manifestations of delusional disorders were described in the article.

From the very first signs to its final formation, delirium goes through three stages: expectation, insight and ordering. At the first stage, the patient is filled with vague premonitions, often of an alarming nature. It seems to him that something must radically change in himself or in the world. At the second stage, insight occurs. Uncertainty disappears and is replaced by the certainty of true knowledge. But this knowledge is still divorced from the world, it exists as a revelation and is not integrated into the patient’s worldview. At the third stage, insight acquires details, acquiring logical integrity. In the case of, for example, delusions of persecution, an “understanding” of the whole picture of the “conspiracy”, the goals and methods of the imaginary persecutors appears. All events, as well as the actions of others, remarks, views - everything is interpreted in the context of delirium. In the end, the worldview is built around the delusional idea, and nothing in the world no longer exists separately from the plot of the delirium.

Delusions can be supplemented by hallucinations, often of a frightening nature. For example, a patient with delusions of persecution can easily “hear” two old women sitting on a bench at the entrance quietly agreeing to kill him. At the same time, he will be absolutely sure of the seriousness of their intentions and any attempts to convince him will be perceived as an element of a conspiracy. Along with delusions and hallucinations, other thinking disorders may be observed, and deviations in the motor sphere, characteristic of other forms of schizophrenia, are also possible. In the case of a long-term and advanced illness, personality degradation is almost inevitable, including delirium. At the final stages of the development of the disease, the so-called disintegration of delirium occurs. The patient begins to get confused in his ideas about himself and others, loses the clarity and integrity of the delusional idea. If previously the patient was able to interact at least somewhat effectively with the world, then at this stage complete disability actually occurs.

Compared to other forms of schizophrenia, paranoid schizophrenia poses the greatest danger to society. The patient may begin to actively defend against perceived dangers and cause harm to others. In principle, attempting to implement any crazy ideas can be dangerous. However, statistics show that the number of crimes committed by mentally ill people is no more than that of healthy people. The probability of cure is higher, the more late age and the onset of the disease occurred more violently.

Hebephrenic form of schizophrenia

This form manifests itself in more early age than paranoid, more often in adolescence. At first, the teenager’s behavior is perceived as an ordinary prank. He is mobile, active, constantly doing some funny things, grimacing and being mischievous. After several months, parents and school teachers begin to become wary. The patient's behavior becomes more and more strange, his speech becomes very fast and incomprehensible. Jokes and antics begin to repeat themselves and gradually lose touch with reality, completely obeying some internal rhythms of the patient. They no longer become funny, but creepy, and their behavior clearly begins to show a severe mental disorder. It is at this stage that an appeal to a psychiatrist occurs. The disease begins violently, progresses quickly, and the prognosis is often unfavorable.

Catatonic form of schizophrenia

This form of the disease mainly affects the motor sphere. The patient can freeze for a long time in complete immobility, even in an uncomfortable position. In other cases, extreme motor agitation is possible—boisterousness. Sometimes excitement alternates with numbness. Both excitation and inhibition may not be universal, but affect only certain segments. For example, the patient’s face may freeze completely, and speech may slow down or stop completely. In the case of similar arousal, rich and rapidly changing facial expressions may appear, accompanying accelerated and confused speech. In a state of violence, the patient is scary and very strong, but his actions are senseless, unsystematic, and have no intention; they are dominated by the desire to break free and run away. Both during periods of stupor and during periods of excitement, patients usually do not feel hungry or tired and, in the absence of force feeding, can reach extreme exhaustion. Modern drugs can significantly weaken and shorten attacks. The prognosis is more favorable than with the simple and hebephrenic form.

Simple form of schizophrenia

In fact, this is not a simple form at all. Her specificity is that she does not have dramatic symptoms such as hallucinations, delusions or motor impairment. It is characterized by a constant increase in the main schizophrenic symptoms in the form of isolation, idleness, painful self-focus, emotional dullness and thinking disorders. In this regard, the disease is quite difficult to recognize, and some researchers attribute it not to schizophrenia at all, but to personality disorders.

The patient ceases to worry about his own fate and the fate of loved ones. He fulfills his duties at work or study without effort, just for show, and therefore his productivity decreases. The patient withdraws into himself, sometimes he may have strange fantasies about the structure and features of his body and he comes up with various rituals regarding these features. He can look at his body or his reflection in the mirror for a long time. All this is accompanied by alienation and increasing emotional dullness. In some cases, delusional ideas of philosophical content or concerning the structure of the body are possible. On later stages As the disease progresses, symptoms characteristic of other forms of schizophrenia may appear. The disease develops unnoticed and slowly, which delays the time to seek help and worsens the prognosis.

Mental illnesses are inexplicable and mysterious. Society shuns people suffering from them. Why is this happening? Could it be that some forms of mental illness are airborne? The mysterious word “schizophrenic” evokes a huge number of conflicting feelings and negative associations. But who is a schizophrenic and is he dangerous to others?

A little history

The term "schizophrenia" was formed from two Greek words: “schizo” - splitting, “fren” - mind. The name of the disease was coined by psychiatry professor Paul Eugen Bleuler and stated that it should remain relevant until scientists find an effective cure. The symptoms of the disease itself were described by a psychiatrist from Russia back in 1987, although at that time it had a different name - “ideophrenia.”

Who is a schizophrenic? Bright minds are looking for an answer to this question. A lot is known about the disease and nothing is unknown. Normal behavior is mixed with inadequacy, smart thoughts border on implausible nonsense. Bleuler called this emotional, volitional and intellectual ambivalence.

Most often, at the initial stage, only the family guesses about the condition of the relative. The fact is that the disease manifests itself in a very strange way: a patient with schizophrenia rejects loved ones, and in relation to them all deviations from the norm and symptoms of the disease are noticeable, while with friends and colleagues the behavior remains the same. There is a completely logical and reasonable explanation for this. Formal, superficial communication does not require such colossal emotional costs as a spiritual connection. The personality is damaged and is at the stage of destruction, so love is a painful sphere; a person has neither moral nor physical strength to waste himself on it.

Symptoms

So who is a schizophrenic? This is a person suffering from a serious illness, which is characterized by a number of symptoms:

• Emotional coldness appears. A person’s feelings for relatives and friends fade away. Gradually, complete indifference is replaced by causeless aggression and anger towards loved ones.
• Lost interest in entertainment and hobbies. Aimless empty days give way to favorite activities.
• Instinctive feelings weaken. This is characterized by the fact that a person may skip meals, ignore extreme heat or cold, bring his own appearance beyond recognition: untidiness, sloppiness, absolute indifference to clothing and basic daily procedures (brushing teeth, caring for face, body, hair, etc.) appears.
• There may be statements that do not stand up to criticism, delusional ideas, strange and inappropriate remarks.
• Auditory and visual hallucinations. The danger is that sometimes verbal voices do not just convey information, but encourage action: to cause serious harm to oneself or others.
• Who is a schizophrenic? First of all, this is a person who is susceptible to many different phobias and unreasonable fears and suffers from depersonalization.
• At an early stage, obsessions (frightening images and images) appear.
• You can also observe lethargy, apathy, insomnia, lethargy and complete absence sexual needs.

State of psychosis

The state of psychosis refers to a spring exacerbation in schizophrenics. It is characterized by a loss of connection with the real world. Orientation decreases usual symptoms take on a hypertrophied form. It is believed that even a healthy person experiences some discomfort in the autumn-spring period. This is expressed by melancholy, general lethargy of the body, vitamin deficiency, and decreased performance.

Nevertheless, many “healers of the soul” claim that spring exacerbation in schizophrenics is more a myth than a reality. The worsening of the disease is extremely rarely confined to a specific time of year.

Rosenhan experiment

Back in 1973, psychologist D. Rosenhan conducted an unprecedented and risky experiment. He explained to the whole world how to become schizophrenic and return to normal again. He was well versed in the symptoms of the disease, and did it so well that he was able to feign schizophrenia, get admitted to a psychiatric clinic with such a diagnosis, and a week later be completely “cured” and go back home.

Some time later interesting experience was repeated, but now the brave psychologist was in the company of equally brave friends. Each of them knew perfectly well how to become schizophrenic, and then skillfully portray healing. The story is interesting and instructive because they were discharged with the wording “schizophrenia in remission.” Does this mean that psychiatrists leave no chance for recovery and that the terrible diagnosis will haunt you for the rest of your life?

Great madmen

The topic “Famous schizophrenics” causes a lot of noisy debate. IN modern world This unflattering epithet is awarded to almost every person who has achieved unprecedented heights in art or some other activity. Every second writer, artist, actor, scientist, poet and philosopher is called schizophrenic. Naturally, there is little truth in these statements, and people tend to confuse talent, eccentricity and creativity with signs of mental illness.

The Russian writer Nikolai Vasilyevich Gogol suffered from this disease. The attacks of psychosis mixed with excitement and activity bore fruit. It is schizophrenia that causes attacks of fear, hypochondria, and claustrophobia. When the condition worsened, the famous manuscript was burned. The writer explained this by the machinations of Satan.

Vincent Van Gogh suffered from schizophrenia. Joy and bouts of happiness were replaced by suicidal thoughts. The disease progressed, the X-hour came for the painter - the famous operation took place, during which he cut off part of his ear and sent this fragment to his beloved as a souvenir, after which he was sent to an institution for the mentally ill.

The German philosopher Friedrich Nietzsche was diagnosed with schizophrenia. His behavior was not distinguished by adequacy; delusions of grandeur were a characteristic feature. There is a theory that it was his works that influenced Adolf Hitler’s worldview and strengthened his desire to become “master of the world.”

It's no secret that schizophrenic scientists are not a myth. A striking example- American mathematician John Forbes Nash. His diagnosis is " paranoid schizophrenia"John became known to the whole world thanks to the film “A Beautiful Mind.” He refused to take pills, explaining that they could negatively affect his mental abilities. Those around him treated him like a harmless madman, but the mathematician was still awarded the Nobel Prize .

How to recognize a schizophrenic?

But of course, the presence of some examples from the list does not mean that the person is seriously ill. Such a diagnosis is made by competent specialists very carefully and carefully. After all, schizophrenia is a stigma and, to some extent, a sentence.

How not to incur the wrath of the patient?

As mentioned above, society shuns people with mental disorders, but this is impossible when a family member is schizophrenic. What to do in such a situation? First of all, carefully read the information on how to behave with a schizophrenic. There are a number of rules:

1. Do not ask questions aimed at clarifying the details of delusional statements.
2. Do not argue, trying to prove the invalidity of the patient’s statements.
3. If the patient experiences too much emotion (fear, anger, hatred, sadness, anxiety), try to calm him down. But don't forget to call a doctor.
4. Express your own opinions with great caution.
5. Don't mock and don't be afraid.

Paranoid schizophrenia

Who is the person who suffers? crazy ideas(jealousy, persecution), subject to fears, doubts, hallucinations, impaired thinking. The disease occurs in people over 25 years of age and at the initial stage is sluggish in nature. This is one of the most common forms of schizophrenia.

"Severe madness" of a child

For parents, there is nothing worse than a sick child. Schizophrenic children are not uncommon. They are, of course, different from their peers. The disease can occur even in the first year of life, but manifest itself much later. Gradually, the child becomes withdrawn, abstracts himself from loved ones, and one may notice a complete loss of interest in ordinary activities. The sooner a problem is detected, the more effective the fight against it will be. There are some signs that should alert you:

• Walking in circles and from side to side.
• Rapid excitation and almost instant extinction.
• Impulsiveness.
• Unmotivated tears, hysterics, laughter, aggression.
• Cold.
• Lethargy, lack of initiative.
• Disintegration of speech combined with immobility.
• Ridiculous behavior.

Scary with its complications. If the process arose at the stage of personality formation, then an oligophrenia-like defect with mental retardation may appear.

Alternative Treatment

There is one interesting theory on how to change the life of a schizophrenic. Why have doctors of sciences, professors and the most brilliant doctors of our time still not found an effective way to cure? It's very simple: schizophrenia is a disease of the soul, therefore drug treatment does not contribute to recovery, but only aggravates its course.

The temple of the Lord can become a panacea; it is he who heals souls. Of course, at first no one adopts this method, but later, when relatives become desperate, they are ready to try everything. And surprisingly, faith in the healing and power of the church can work a miracle.

Worsening of the disease

An exacerbation in schizophrenics can throw impressionable relatives into panic. Acute period illness requires immediate hospitalization. This will protect the immediate environment and protect the patient himself. Sometimes certain difficulties may arise due to the fact that a schizophrenic does not consider himself a sick person. All arguments of reason will break against the blank wall of his misunderstanding, so you need to act without his consent. It is also necessary to familiarize yourself with the signs indicating an approaching relapse:

• Changing the normal mode.
• Features of behavior that were observed before the previous attack.
• Refusal to see a psychiatrist.
• Absence or excess of emotions.

If the signs are obvious, then it is necessary to notify the attending physician, to reduce the possibility negative impacts on the patient from the outside, do not change the usual rhythm and way of life.

People who have such a relative are often at a loss and do not understand how to exist with him under the same roof. To avoid excesses, it is worth studying information on how to live with a schizophrenic:

• Patients need long-term treatment and must be constantly monitored.
• During therapy there will certainly be exacerbations and relapses.
• It is necessary to create a volume of work and household chores for the patient and never exceed it.
• Excessive care can cause harm.
• You shouldn’t get angry, scream, or get irritated with mentally ill people. They are unable to bear criticism.

You also need to know the signs of an impending suicide attempt:

1. General statements about the meaninglessness and frailty of existence, the sinfulness of people.
2. Hopeless pessimism.
3. Voices commanding suicide.
4. The patient's belief that he is suffering from an incurable disease.
5. Sudden calm and fatalism.

To prevent tragedy, you should learn to distinguish the “normal” behavior of a schizophrenic from the abnormal. One cannot ignore his conversations about the desire to commit suicide; an ordinary person is capable of seeking attention to his own person in this way, but with a schizophrenic everything is different. You should try to convey to his mind that the illness will soon go away and relief will come. But this needs to be done gently and unobtrusively.

It is bad if the patient suffers from alcohol or drug addiction, the course of the disease significantly complicates the rehabilitation process, causes drug resistance, and also increases the tendency to violence.

The topic of violence stands apart here. And many people are concerned about the question: is it likely that a schizophrenic will harm others? It is worth noting right away that this is exaggerated. Of course, there have been precedents, but if you establish a trusting relationship with a mentally ill person and care for him correctly, the risk is completely eliminated.

Traditionally, the following forms of schizophrenia have been identified:

Simple schizophrenia is characterized by the absence of productive symptoms and the presence of clinical picture only actual schizophrenic symptoms.

Hebephrenic schizophrenia (may include hebephrenic-paranoid and hebephrenic-catatonic states).

Catatonic schizophrenia (severe disturbances or absence of movements; may include catatonic-paranoid states).

Paranoid schizophrenia (there are delusions and hallucinations, but no speech disorders, erratic behavior, emotional impoverishment; includes depressive-paranoid and circular variants).

The following forms of schizophrenia are now also distinguished:

Hebephrenic schizophrenia

Catatonic schizophrenia

Paranoid schizophrenia

Residual schizophrenia (low intensity of positive symptoms)

Mixed, undifferentiated schizophrenia (schizophrenia does not belong to any of the listed forms)

The most common paranoid form of schizophrenia, which is characterized primarily by delusions of persecution. Although other symptoms—thought disturbances and hallucinations—are also present, delusions of persecution are the most noticeable. It is usually accompanied by suspicion and hostility. Constant fear generated by delusional ideas is also characteristic. Delusions of persecution can be present for years and develop significantly. As a rule, patients with paranoid schizophrenia do not experience any noticeable changes in behavior or intellectual and social degradation, which are noted in patients with other forms. The patient's functioning may appear surprisingly normal until his delusions are affected.

The hebephrenic form of schizophrenia differs from the paranoid form both in symptoms and outcome. The predominant symptoms are marked difficulty in thinking and disturbances in affect or mood. Thinking can be so disorganized that the ability to communicate meaningfully is lost (or almost lost); affect in most cases is inadequate, the mood does not correspond to the content of thinking, so that as a result, sad thoughts can be accompanied by a cheerful mood. In the long term, most of these patients expect significant social behavior disorder, manifested, for example, by a tendency to conflict and an inability to maintain work, family and close human relationships.

Catatonic schizophrenia is characterized primarily by abnormalities in the motor sphere, present throughout almost the entire course of the disease. Abnormal movements come in a wide variety of forms; This may include abnormal posture and facial expression, or performing almost any movement in a strange, unnatural way. The patient can spend hours in an awkward and uncomfortable mannered position, alternating it with unusual actions such as repeated stereotypical movements or gestures. The facial expression of many patients is frozen, facial expressions are absent or very poor; Some grimaces like pursing of lips are possible. Seemingly normal movements are sometimes suddenly and inexplicably interrupted, sometimes giving way to strange motor behavior. Along with pronounced motor abnormalities, many other already discussed symptoms of schizophrenia are noted - paranoid delusions and other thinking disorders, hallucinations, etc. The course of the catatonic form of schizophrenia is similar to the hebephrenic one, however, severe social degradation, as a rule, develops in a later period of the disease.

Another “classical” type of schizophrenia is known, but it is observed extremely rarely and its identification as a separate form of the disease is disputed by many experts. This simple schizophrenia, first described by Bleuler, who applied the term to patients with disturbances of thought or affect, but without delusions, catatonic symptoms or hallucinations. The course of such disorders is considered progressive with the outcome in the form of social maladjustment.

The book edited by Tiganov A. S. “Endogenous mental diseases” provides a more expanded and supplemented classification of forms of schizophrenia. All data is summarized in one table:

“The question of the classification of schizophrenia since its identification as an independent nosological form remains controversial. There is still no uniform classification of clinical variants of schizophrenia for all countries. However, there is a certain continuity of modern classifications with those that appeared when schizophrenia was identified as a nosologically independent disease. In this regard, E. Kraepelin’s classification deserves special attention, which is still used by both individual psychiatrists and national psychiatric schools.

E. Kraepelin identified catatonic, hebephrenic and simple forms of schizophrenia. In simple schizophrenia that occurs in adolescence, he noted a progressive impoverishment of emotions, intellectual unproductivity, loss of interests, increasing lethargy, isolation; he also emphasized the rudimentary nature of positive psychotic disorders (hallucinatory, delusional and catatonic disorders). He characterized hebephrenic schizophrenia by foolishness, disruption of thinking and speech, catatonic and delusional disorders. Both simple and hebephrenic schizophrenia are characterized by an unfavorable course, while at the same time, with hebephrenia, E. Kraepelin did not exclude the possibility of remissions. In the catatonic form, the predominance of the catatonic syndrome was described in the form of both catatonic stupor and agitation, accompanied by pronounced negativism, delusional and hallucinatory inclusions. In the later identified paranoid form, there was a dominance of delusional ideas, usually accompanied by hallucinations or pseudohallucinations.

Subsequently, circular, hypochondriacal, neurosis-like and other forms of schizophrenia were also identified.

The main disadvantage of E. Kraepelin's classification is its statistical nature, associated with the main principle of its construction - the predominance of one or another psychopathological syndrome in the clinical picture. Further studies confirmed the clinical heterogeneity of these forms and their different outcomes. For example, the catatonic form turned out to be completely heterogeneous in clinical picture and prognosis; heterogeneity of acute and chronic delusional states and hebephrenic syndrome was discovered.

In ICD-10 there are the following forms of schizophrenia: paranoid simple, hebephrenic, catatonic, undifferentiated and residual. The classification of the disease also includes post-schizophrenic depression, “other forms” of schizophrenia and unsubtle schizophrenia. If the classical forms of schizophrenia do not require special comments, then the criteria for undifferentiated schizophrenia seem extremely amorphous; As for post-schizophrenic depression, its identification as an independent category is largely debatable.

Research into the patterns of development of schizophrenia, conducted at the Department of Psychiatry of the Central Institute for Advanced Medical Studies and at the Scientific Center mental health RAMS under the leadership of A.V. Snezhnevsky, showed the validity of the dynamic approach to the problem of morphogenesis and the importance of studying the relationship between the type of disease and its syndromic characteristics at each stage of disease development.

Based on the results of these studies, 3 main forms of the course of schizophrenia were identified: continuous, recurrent (periodic) and paroxysmal-progressive with varying degrees of progression (roughly, moderately and slightly progressively).

Continuous schizophrenia included cases of the disease with a gradual progressive development of the disease process and a clear delineation of its clinical varieties according to the degree of progression - from sluggish with mildly expressed personality changes to grossly progressive with the severity of both positive and negative symptoms. Sluggish schizophrenia is classified as continuous schizophrenia. But given that it has a number of clinical features and, in the above sense, its diagnosis is less certain, a description of this form is given in the section “Special forms of schizophrenia.” This is reflected in the classification below.

The paroxysmal course, which distinguishes recurrent or periodic schizophrenia, is characterized by the presence of phases in the development of the disease with the occurrence of distinct attacks, which brings this form of the disease closer to manic-depressive psychosis, especially since affective disorders occupy a significant place in the picture of attacks, and personality changes not clearly expressed.

An intermediate place between the indicated types of course is occupied by cases when, in the presence of a continuously ongoing disease process with neurosis-like, paranoid, psychopath-like disorders, the appearance of attacks is noted, the clinical picture of which is determined by syndromes similar to attacks of recurrent schizophrenia or to conditions of another psychopathological structure characteristic of p and - stuporous -progressive schizophrenia.

The above classification of forms of schizophrenia reflects opposite trends in the development of the disease process - favorable with its characteristic paroxysmal nature and unfavorable with its characteristic continuity. These two trends are most clearly expressed in the typical variants of continuous and periodic (recurrent) schizophrenia, but between them there are many transitional variants that create a continuum of the course of the disease. This must be taken into account in clinical practice.

Here we present a classification of the forms of schizophrenia, focused not only on the most typical variants of its manifestations, but on atypical, special forms of the disease.

Classification of forms of schizophrenia

Continuously flowing

Malignant juvenile

Hebephrenic

Catatonic

Paranoid youth

Paranoid

Crazy option

Hallucinatory variant

Sluggish

Paroxysmal-progressive

Malignant

Close to paranoid

Close to sluggish

Recurrent:

WITH different types seizures

With the same type of attacks

Special forms

Sluggish

Atypical prolonged pubertal seizure

Paranoid

Febrile

Since doctors and scientists now quite often have to diagnose schizophrenia not only according to the domestic classification, but also according to ICD-10, we decided to give an appropriate comparison of the forms of the disease (Table 7) according to A. S. Tiganov, G. P. Panteleeva, O.P. Vertogradova et al. (1997). Table 7 contains some discrepancies with the above classification. They are due to the features of ICD-10. In it, for example, among the main forms there is no sluggish schizophrenia distinguished in the domestic classification, although this form was listed in ICD-9: heading 295.5 “Sluggish (slightly progressive, latent) schizophrenia” in 5 variants. In ICD-10, low-grade schizophrenia mainly corresponds to “Schizotypal disorder” (F21), which is included in the general heading “Schizophrenia, schizotypal and delusional disorders"(F20-29). In Table 7, among the forms of paroxysmal-progressive schizophrenia, the previously distinguished [Nadzharov R. A., 1983] schizoaffective schizophrenia is left, since in ICD-10 it corresponds to a number of distinguished conditions, taking into account the forms (types) of the course of the disease. In this Guide, schizoaffective schizophrenia is classified as a schizoaffective psychosis and is discussed in Chapter 3 of this section. In the Manual of Psychiatry, edited by A. V. Snezhnevsky (1983), schizoaffective psychoses were not highlighted.”

Table 7. Schizophrenia: comparison of diagnostic criteria of ICD-10 and domestic classification

Domestic taxonomy of forms of schizophrenia
I. Continuous schizophrenia	1. Schizophrenia, continuous course
a) malignant catatonic variant (“lucid” catatonia, hebephrenic)	a) catatonic schizophrenia, hebephrenic schizophrenia
hallucinatory-delusional variant (youthful paranoid)	undifferentiated schizophrenia with a predominance of paranoid disorders
simple form	simple schizophrenia
final state	residual schizophrenia, continuous
	b) paranoid schizophrenia
paranoid schizophrenia (paranoid stage)	paranoid schizophrenia, delusional disorder
crazy option	paranoid schizophrenia, chronic delusional disorder
hallucinatory variant	paranoid schizophrenia, other psychotic disorders (chronic hallucinatory psychosis)
incomplete remission	paranoid schizophrenia, other chronic delusional disorders, residual schizophrenia, incomplete remission	F20.00+ F22.8+ F20.54
II. Paroxysmal-progressive (fur-like) schizophrenia	II. Schizophrenia, episodic course with increasing defect
a) malignant with a predominance of catatonic disorders (including “lucid” and hebephrenic variants)	a) catatonic (hebephrenic) schizophrenia
with a predominance of paranoid disorders	paranoid schizophrenia
with polymorphic manifestations (affective-catatonic-hallucinatory-delusional)	schizophrenia undifferentiated
b) paranoid (progressive)	b) paranoid schizophrenia
crazy option	paranoid schizophrenia, other acute delusions psychotic disorders
hallucinatory version remission	paranoid schizophrenia, other acute psychotic disorders paranoid schizophrenia, episodic course with a stable defect, with incomplete remission	F20.02+ F23.8+ F20.02+ F20.04
c) schizoaffective	c) schizophrenia, episodic type of course with a stable defect. Schizoaffective disorder
depressive-delusional (depressive-catatonic) attack	schizoaffective disorder, depressive type, schizophrenia with episodic course, with a stable defect, acute polymorphic psychotic disorder with symptoms of schizophrenia	F20.x2(F20.22)+ F25.1+ F23.1
manic-delusional (manic-catatonic) attack	schizoaffective disorder, manic type, schizophrenia with episodic course and with a stable defect, acute polymorphic, psychotic disorder with symptoms of schizophrenia	F20.x2(F20.22)+ F25.0+ F23.1
thymopathic remission (with “acquired” cyclothymia)	schizophrenia, incomplete remission, post-schizophrenic depression, cyclothymia
III. Recurrent schizophrenia	III. Schizophrenia, episodic relapsing course
oneiric-catatonic attack	catatonic schizophrenia, acute polymorphic psychotic disorder without symptoms of schizophrenia
acute sensual delirium (intermetamorphosis, acute fantastic delirium)	schizophrenia, acute polymorphic psychotic disorder without symptoms of schizophrenia
acute delusional state of the type of acute hallucinosis and acute Kandinsky-Clerambault syndrome	schizophrenia, acute psychotic state with symptoms of schizophrenia
acute paranoid	schizophrenia, other acute, predominantly delusional, psychotic disorders
circular schizophrenia	schizophrenia, other manic episode (other depressive episodes, atypical depression)	F20.x3+ F30.8 (or F32.8)
remission without productive disorders	schizophrenia, complete remission

Schizophrenia is equally common among both sexes.

The issue of the prevalence of the disease is very complex due to different diagnostic principles in different countries and different regions within one country, and the lack of a single complete theory of schizophrenia. On average, the prevalence is about 1% in the population or 0.55%. There is evidence of a more frequent incidence among the urban population.

In general, the diagnostic boundaries between different forms of schizophrenia are somewhat blurred, and ambiguity can and does occur. However, the classification has been maintained since the early 1900s because it has proven useful in both predicting disease outcome and describing it.

Psychological characteristics of patients with schizophrenia

Since the time of E. Kretschmer, schizophrenia has been commonly associated with a schizoid personality type, which in the most typical cases is characterized by introversion, a tendency to abstract thinking, emotional coldness and restraint in the manifestation of feelings, combined with obsession in the implementation of certain dominant aspirations and hobbies. But as they studied various forms of schizophrenia, psychiatrists moved away from such generalized characteristics of premorbid patients, which turned out to be very different in different clinical forms of the disease [Nadzharov R. A., 1983].

There are 7 types of pre-morbid personality characteristics of patients with schizophrenia: 1) hyperthymic individuals with traits of immaturity in the emotional sphere and a tendency to daydreaming and fantasizing; 2) sthenic schizoids; 3) sensitive schizoids; 4) dissociated, or mosaic, schizoids; 5) excitable individuals; 6) “exemplary” individuals; 7) deficit individuals.

A premorbid personality type of the hyperthymic type has been described in patients with an attack-like form of schizophrenia. Sthenic schizoids occur in various forms. Sensitive schizoids have been described both in paroxysmal forms of schizophrenia and in its sluggish course. The personality type of dissociated schizoid is characteristic of sluggish schizophrenia. Personalities of the excitable type are found in different forms of the disease (paroxysmal, paranoid and sluggish). The types of “exemplary” and deficient personalities are especially characteristic of forms of malignant juvenile schizophrenia.

Significant progress in the study of premorbids was achieved after establishing the psychological characteristics of patients, in particular, in identifying the structure of the schizophrenic defect.

Interest in the psychology of patients with schizophrenia arose a long time ago in connection with the uniqueness of mental disorders in this disease, in particular due to the unusualness of cognitive processes and the impossibility of assessing them in accordance with the known criteria for dementia. It was noted that the thinking, speech and perception of patients are unusual and paradoxical, having no analogy among other known types of corresponding mental pathology. Most authors pay attention to a special dissociation that characterizes not only cognitive, but also all mental activity and behavior of patients. Thus, patients with schizophrenia can perform complex types of intellectual activity, but often have difficulty solving simple problems. Their methods of action, inclinations and hobbies are also often paradoxical.

Psychological studies have shown that disturbances in cognitive activity in schizophrenia occur at all levels, starting from the direct sensory reflection of reality, i.e. perception. Various properties of the surrounding world are highlighted by patients somewhat differently than by healthy people: they are “emphasized” differently, which leads to a decrease in the efficiency and “economy” of the perception process. However, there is an increase in the “perceptual accuracy” of image perception.

The most clearly marked features of cognitive processes appear in the thinking of patients. It was found that in schizophrenia there is a tendency to actualize practically insignificant features of objects and a decrease in the level of selectivity due to the regulatory influence of past experience on mental activity. At the same time, this mental pathology, as well as speech activity and visual perception, designated as dissociation, appears especially clearly in those types of activities, the implementation of which is significantly determined by social factors, that is, it involves reliance on the past social experience. In the same types of activities where the role of social mediation is insignificant, no violations are found.

The activities of patients with schizophrenia, due to a decrease in social orientation and the level of social regulation, are characterized by a deterioration in selectivity, but patients with schizophrenia in this regard can in some cases receive a “gain”, experiencing less difficulties than healthy people, if necessary, discover “latent” knowledge or discover new ones in a subject properties. However, the “loss” is immeasurably greater, since in the vast majority of everyday situations, a decrease in selectivity reduces the effectiveness of patients. Reduced selectivity is at the same time the foundation of “original” and unusual thinking and perception of patients, allowing them to consider phenomena and objects from different angles, compare incomparable things, and move away from templates. There are many facts confirming the presence of special abilities and inclinations in people of the schizoid circle and patients with schizophrenia, allowing them to achieve success in certain areas of creativity. It was these features that gave rise to the problem of “genius and insanity.”

By reducing the selective updating of knowledge, patients who, according to premorbid characteristics, are classified as sthenic, mosaic, and also hyperthymic schizoids are significantly different from healthy people. Sensitive and excitable schizoids occupy an intermediate position in this regard. These changes are uncharacteristic of patients who in premorbid are classified as deficient and “exemplary” individuals.

Features of the selectivity of cognitive activity in speech are as follows: in patients with schizophrenia, there is a weakening of the social determination of the process of speech perception and a decrease in the actualization of speech connections based on past experience.

In the literature, there has been data for a relatively long time about the similarity of the “general cognitive style” of thinking and speech of patients with schizophrenia and their relatives, in particular parents. Data obtained by Yu. F. Polyakov et al. (1983, 1991) in experimental psychological studies conducted at the Scientific Center for Mental health RAMS, indicate that among relatives of mentally healthy patients with schizophrenia there is a significant accumulation of individuals with varying degrees of severity of anomalies in cognitive activity, especially in cases where they are characterized by personality characteristics similar to probands. In the light of these data, the problem of “genius and insanity” also looks different, which should be considered as an expression of the constitutional nature of the identified changes in thinking (and perception) that contribute to the creative process.

In a number of recent works, certain psychological characteristics are considered as predisposition factors (“vulnerability”), on the basis of which schizophrenic episodes can occur due to stress. As such factors, employees of the New York group L. Erlenmeyer-Kimung, who have been studying children at high risk for schizophrenia for many years, identify deficits in information processes, dysfunction of attention, impaired communication and interpersonal functioning, low academic and social “competence”.

The general result of such studies is the conclusion that a deficit in a number of mental processes and behavioral reactions characterizes both patients with schizophrenia themselves and individuals with an increased risk of developing this disease, i.e., the corresponding features can be considered as predictors of schizophrenia.

The peculiarity of cognitive activity identified in patients with schizophrenia, which consists in a decrease in the selective updating of knowledge, does not. is a consequence of the development of the disease. It is formed before the manifestation of the latter, predispositionally. This is evidenced by the absence of a direct connection between the severity of this anomaly and the main indicators of the movement of the schizophrenic process, primarily its progression.

Note that during the disease process, a number of characteristics of cognitive activity undergo changes. Thus, the productivity and generalization of mental activity, the contextual conditioning of speech processes decrease, the semantic structure of words disintegrates, etc. However, such a feature as a decrease in selectivity is not associated with the progression of the disease process. In connection with what was said in last years The psychological structure of the schizophrenic defect - the pathopsychological syndrome of the schizophrenic defect - attracts especially great attention. In the formation of the latter, two trends are distinguished - the formation of a partial, or dissociated, on the one hand, and a total, or pseudo-organic defect, on the other [Kritskaya V.P., Meleshko T.K., Polyakov Yu.F., 1991]..

The leading component in the formation of a partial, dissociated type of defect is a decrease in the need-motivational characteristics of social regulation of activity and behavior. The insufficiency of this component of mental activity leads to a decrease in the social orientation and activity of the individual, to a lack of communication, social emotions, limits reliance on social norms and reduces the level of activity mainly in those areas that require reliance on past social experience and social criteria. The level of regulation remains quite high in these patients in those types of activities and in situations where the role of the social factor is relatively small. This creates a picture of dissociation and partial manifestation of mental disorders in these patients.

When this type of defect is formed, which is designated as total, pseudo-organic, a decrease in the need-motivational component of mental activity comes to the fore, manifesting itself globally and covering all or most types of mental activity, which characterizes the patient’s behavior as a whole. Such a total deficit of mental activity leads, first of all, to a sharp decrease in initiative in all spheres of mental activity, a narrowing of the range of interests, a decrease in the level of its voluntary regulation and creative activity. Along with this, formal-dynamic performance indicators also deteriorate, and the level of generalization decreases. It should be emphasized that a number of specific characteristics of the schizophrenic defect, which are so pronounced in the dissociated type of the latter, tend to be smoothed out due to a global decrease in mental activity. It is significant that this decrease is not a consequence of exhaustion, but is due to the insufficiency of need-motivational factors in the determination of mental activity.

In pathopsychological syndromes characterizing different types defect can be distinguished both common and different features. Their common feature is a decrease in the need-motivational components of social regulation of mental activity. This deficiency is manifested by violations of the main components of the leading component of the psychological syndrome: a decrease in the level of communication of social emotions, the level of self-awareness, and selectivity of cognitive activity. These features are most pronounced in the case of a partial type defect - a kind of dissociation of mental disturbances occurs. The leading component of the second type of defect, pseudo-organic, is a violation of the need-motivational characteristics of mental activity, leading to a total decrease in predominantly all types and parameters of mental activity. In this picture of a general decrease in the level of mental activity, only individual “islands” of preserved mental activity related to the interests of patients can be noted. Such a total decrease smoothes out the manifestations of dissociation of mental activity.

In patients, there is a close connection between the negative changes that characterize the partial defect and constitutionally determined, premorbid personality characteristics. During the disease process, these features change: some of them deepen even more, and some are smoothed out. It is no coincidence that a number of authors called this type of defect a defect of schizoid structure. In the formation of the second type of defect with a predominance of pseudoorganic disorders, along with the influence of constitutional factors, a more pronounced connection is revealed with the factors of the movement of the disease process, primarily with its progression.

Analysis of the schizophrenic defect from the standpoint of the pathopsychological syndrome allows us to substantiate the main principles of corrective influences for the purposes of social and labor adaptation and rehabilitation of patients, according to which the deficiency of some components of the syndrome is partially compensated by others, which are relatively more intact. Thus, the deficit of emotional and social regulation of activity and behavior can, to a certain extent, be compensated in a conscious way on the basis of voluntary and volitional regulation of activity. The deficit of need-motivational characteristics of communication can be overcome to some extent by including patients in specially organized joint activities with a clearly defined goal. The motivating stimulation used in these conditions does not directly appeal to the patient’s feelings, but presupposes awareness of the need to focus on the partner, without which the task cannot be solved at all, i.e. compensation is achieved in these cases also through the intellectual and volitional efforts of the patient. One of the tasks of correction is to generalize and consolidate positive motivations created in specific situations, facilitating their transition into stable personal characteristics.

Genetics of schizophrenia

(M. E. Vartanyan/V. I. Trubnikov)

Population studies of schizophrenia - the study of its prevalence and distribution among the population - have made it possible to establish the main pattern - the relative similarity of the prevalence rates of this disease in mixed populations of different countries. Where the registration and identification of patients meet modern requirements, the prevalence of endogenous psychoses is approximately the same.

Hereditary endogenous diseases, in particular schizophrenia, are characterized by high prevalence rates in the population. At the same time, a reduced birth rate has been established in families of patients with schizophrenia.

The lower reproductive capacity of the latter, explained by their long stay in hospital and separation from the family, a large number of divorces, spontaneous abortions and other factors, all other things being equal, should inevitably lead to a decrease in morbidity rates in the population. However, according to the results of population-based epidemiological studies, the expected decrease in the number of patients with endogenous psychoses in the population does not occur. In this regard, a number of researchers have suggested the existence of mechanisms that balance the process of elimination of schizophrenic genotypes from the population. It was assumed that heterozygous carriers (some relatives of patients), unlike patients with schizophrenia themselves, have a number of selective advantages, in particular increased reproductive ability compared to the norm. Indeed, it has been proven that the birth rate of children among first-degree relatives of patients is higher than the average birth rate in this population group. Another genetic hypothesis explaining the high prevalence of endogenous psychoses in the population postulates high hereditary and clinical heterogeneity of this group of diseases. In other words, combining diseases that are different in nature under one name leads to an artificial increase in the prevalence of the disease as a whole.

A study of families of probands suffering from schizophrenia has convincingly shown the accumulation in them of cases of psychosis and personality anomalies, or “schizophrenia spectrum disorders” [Shakhmatova I.V., 1972]. In addition to pronounced cases of manifest psychoses in families of patients with schizophrenia, many authors described a wide range of transitional forms of the disease and a clinical variety of intermediate variants (sluggish course of the disease, schizoid psychopathy, etc.).

To this should be added some features of the structure of cognitive processes, described in the previous section, characteristic of both patients and their relatives, which are usually assessed as constitutional factors predisposing to the development of the disease [Kritskaya V.P., Meleshko T.K., Polyakov Yu.F. , 1991].

The risk of developing schizophrenia in parents of patients is 14%, in brothers and sisters - 15-16%, in children of sick parents - 10-12%, in uncles and aunts - 5-6%.

There is evidence of the dependence of the nature of mental abnormalities within a family on the type of course of the disease in the proband (Table 8).

Table 8. Frequency of mental abnormalities in first-degree relatives of probands with various forms course of schizophrenia (in percent)

Table 8 shows that among the relatives of a proband suffering from ongoing schizophrenia, cases of psychopathy (especially of the schizoid type) accumulate. The number of second cases of manifest psychoses with a malignant course is much less. The reverse distribution of psychoses and personality anomalies is observed in families of probands with a recurrent course of schizophrenia. Here the number of manifest cases is almost equal to the number of cases of psychopathy. The data presented indicate that the genotypes predisposing to the development of continuous and recurrent course of schizophrenia differ significantly from each other.

Many mental anomalies, as if transitional forms between the norm and severe pathology in families of patients with endogenous psychoses, led to the formulation of an important question for genetics about the clinical continuum. The continuum of the first type is determined by multiple transitional forms from complete health to manifest forms of continuous schizophrenia. It consists of schizothymia and schizoid psychopathy of varying severity, as well as latent, reduced forms of schizophrenia. The second type of clinical continuum is transitional forms from normal to recurrent schizophrenia and affective psychoses. In these cases, the continuum is determined by psychopathy of the cycloid circle and cyclothymia. Finally, between the polar, “pure” forms of schizophrenia (continuous and recurrent) there is a range of transitional forms of the disease (paroxysmal-progressive schizophrenia, its schizoaffective variant, etc.), which can also be designated as a continuum. The question arises about the genetic nature of this continuum. If the phenotypic variability of the manifestations of endogenous psychoses reflects the genotypic diversity of the mentioned forms of schizophrenia, then we should expect a certain discrete number of genotypic variants of these diseases, providing “smooth” transitions from one form to another.

Genetic-correlation analysis made it possible to quantify the contribution of genetic factors to the development of the studied forms of endogenous psychoses (Table 9). The heritability indicator (h 2) for endogenous psychoses varies within relatively narrow limits (50-74%). Genetic correlations between forms of the disease have also been determined. As can be seen from Table 9, the genetic correlation coefficient (r) between continuous and recurrent forms of schizophrenia is almost minimal (0.13). This means that the total number of genes included in the genotypes predisposing to the development of these forms is very small. This coefficient reaches its maximum (0.78) values ​​when comparing the recurrent form of schizophrenia with manic-depressive psychosis, which indicates an almost identical genotype that predisposes to the development of these two forms of psychoses. In the paroxysmal-progressive form of schizophrenia, a partial genetic correlation is found with both continuous and recurrent forms of the disease. All these patterns indicate that each of the mentioned forms of endogenous psychoses has a different genetic commonality in relation to each other. This commonality arises indirectly, due to genetic loci common to the genotypes of the corresponding forms. At the same time, there are also differences between them in loci that are characteristic only of the genotypes of each individual form.

Table 9. Genetic-correlation analysis of the main clinical forms of endogenous psychoses (h 2 - heritability coefficient, r g - genetic correlation coefficient)

Clinical form of the disease	Continuous schizophrenia		Recurrent schizophrenia
Continuous schizophrenia
Paroxysmal-progressive schizophrenia
Recurrent schizophrenia
Affective insanity

Thus, the polar variants of endogenous psychoses differ genetically most significantly - Continuous schizophrenia, on the one hand, recurrent schizophrenia and manic-depressive psychosis, on the other. Paroxysmal-progressive schizophrenia is clinically the most polymorphic, genotypically also more complex and, depending on the predominance of continuous or periodic elements in the clinical picture, contains certain groups of genetic loci. However, the existence of a continuum at the genotype level requires more detailed evidence.

The presented results of genetic analysis have raised questions that are important for clinical psychiatry in theoretical and practical terms. First of all, this is a nosological assessment of the group of endogenous psychoses. The difficulties here lie in the fact that their various forms, while having common genetic factors, at the same time (at least some of them) differ significantly from each other. From this point of view, it would be more correct to designate this group as a nosological “class” or “genus” of diseases.

Developing ideas force us to reconsider the problem of heterogeneity of diseases with hereditary predisposition [Vartanyan M. E., Snezhnevsky A. V., 1976]. Endogenous psychoses belonging to this group do not meet the requirements of classical genetic heterogeneity, proven for typical cases of monomutant hereditary diseases, where the disease is determined by a single locus, i.e. one or another of its allelic variants. The hereditary heterogeneity of endogenous psychoses is determined by significant differences in the constellations of different groups of genetic loci that predispose to certain forms of the disease. Consideration of such mechanisms of hereditary heterogeneity of endogenous psychoses allows us to assess the different roles of environmental factors in the development of the disease. It becomes clear why in some cases the manifestation of the disease (recurrent schizophrenia, affective psychoses) often requires external, provoking factors, while in others (continuous schizophrenia) the development of the disease occurs as if spontaneously, without significant environmental influence.

A decisive point in the study of genetic heterogeneity will be the identification of the primary products of genetic loci involved in hereditary structure, predisposition, and the assessment of their pathogenetic effects. In this case, the concept of “hereditary heterogeneity of endogenous psychoses” will receive specific biological content, which will allow for targeted therapeutic correction of the corresponding shifts.

One of the main directions in studying the role of heredity for the development of schizophrenia is the search for their genetic markers. Markers are usually understood as those characteristics (biochemical, immunological, physiological, etc.) that distinguish patients or their relatives from healthy ones and are under genetic control, i.e., they are an element of hereditary predisposition to the development of the disease.

Many biological disorders found in patients with schizophrenia are more common in their relatives compared to a control group of mentally healthy individuals. Such disorders were detected in some mentally healthy relatives. This phenomenon was demonstrated, in particular, for membranotropic, as well as for neurotropic and antithymic factors in the blood serum of patients with schizophrenia, the heritability coefficient (h2) of which is 64, 51 and 64, respectively, and the indicator of genetic correlation with a predisposition to the manifestation of psychosis is 0. 8; 0.55 and 0.25. Recently, indicators obtained from brain CT scans have been very widely used as markers, since many studies have shown that some of them reflect a predisposition to the disease.

The results obtained are consistent with the idea of ​​genetic heterogeneity of schizophrenic psychoses. At the same time, these data do not allow us to consider the entire group of psychoses of the schizophrenia spectrum as the result of the phenotypic manifestation of a single genetic cause (in accordance with simple models of monogenic determination). Nevertheless, the development of the marker strategy in the study of the genetics of endogenous psychoses should continue, as it can serve as a scientific basis for medical genetic counseling and identification of high-risk groups.

Twin studies have played a major role in studying the “contribution” of hereditary factors to the etiology of many chronic non-communicable diseases. They were started in the 20s. Currently, in clinics and laboratories around the world there is a large sample of twins suffering from mental illness [Moskalenko V.D., 1980; Gottesman I. I., Shields J. A., 1967, Kringlen E., 1968; Fischer M. et al, 1969; Pollin W. et al, 1969; Tienari P., 1971]. An analysis of the concordance of identical and fraternal twins (OB and DB) for schizophrenia showed that concordance in OB reaches 44%, and in DB - 13%.

Concordance varies considerably and depends on many factors - the age of the twins, the clinical form and severity of the disease, clinical criteria conditions, etc. These features determine the large differences in published results: concordance in the OB groups ranges from 14 to 69%, in the DB groups - from 0 to 28%. For none of the diseases does the concordance in OB pairs reach 100%. It is generally accepted that this indicator reflects the contribution of genetic factors to the occurrence of human diseases. Discordance between OBs, on the contrary, is determined by environmental influences. However, there are a number of difficulties in interpreting twin concordance data for mental illness. First of all, according to the observations of psychologists, it is impossible to exclude “mutual mental induction,” which is more pronounced in OB than in DB. It is known that OBs are more inclined to mutual imitation in many areas of activity, and this makes it difficult to unambiguously determine the quantitative contribution of genetic and environmental factors to the similarity of OBs.

The twin approach should be combined with all other methods of genetic analysis, including molecular biological ones.

In the clinical genetics of schizophrenia when studying the relationships between hereditary and external factors in development mental illness The most common approach is to study "adopted children - parents." Children in very early childhood are separated from biological parents suffering from schizophrenia and placed in families of mentally healthy people. Thus, a child with a hereditary predisposition to mental illness ends up in a normal environment and is raised by mentally healthy people (adoptive parents). Using this method, S. Kety et al. (1976) and other researchers have convincingly proven the significant role of hereditary factors in the etiology of endogenous psychoses. Children whose biological parents suffered from schizophrenia and who grew up in families of mentally healthy people showed symptoms of the disease with the same frequency as children left in families with schizophrenia. Thus, studies of “adopted children-parents” in psychiatry have made it possible to reject objections to the genetic basis of psychoses. The primacy of psychogenesis in the origin of this group of diseases was not confirmed in these studies.

In recent decades, another area of ​​genetic research in schizophrenia has emerged, which can be defined as the study of “high-risk groups.” These are special long-term projects for monitoring children born to parents with schizophrenia. The most famous are the studies of V. Fish and the “New York High Risk Project”, carried out at the New York State Institute of Psychiatry since the late 60s. V. Fish established the phenomena of dysontogenesis in children from high-risk groups (for a detailed description, see Volume 2, Section VIII, Chapter 4). The children observed as part of the New York project have now reached adolescence and adulthood. Based on neurophysiological and psychological (psychometric) indicators, a number of signs reflecting the characteristics of cognitive processes were established, characterizing not only mentally ill, but also practically healthy individuals from a high-risk group, which can serve as predictors of the occurrence of schizophrenia. This makes it possible to use them to identify groups of people in need of appropriate preventive interventions.

Literature

1. Depression and depersonalization - Nuller Yu.L. Address: Science Center mental health RAMS, 2001-2008 http://www.psychiatry.ru

2. Endogenous mental illnesses - Tiganov A.S. (ed.) Address: Scientific Center for Mental Health of the Russian Academy of Medical Sciences, 2001-2008 http://www.psychiatry.ru

3. M. P. Kononova (Guide to the psychological study of mentally ill children school age(From the experience of working as a psychologist in a children's psychiatric hospital). - M.: State. publishing house of medical literature, 1963.P.81-127).

4. “Psychophysiology”, ed. Yu. I. Alexandrova

Schizophrenia is such a multifaceted disease in its manifestations that recognizing it in time can sometimes be quite difficult. Before the first obvious signs the disease can slowly develop over years, and some oddities that appear in a person’s behavior are mistaken by many for a spoiled character or teenage changes. At the same time, having noticed such oddities, people often, instead of turning to a psychologist or psychiatrist, run to grandmothers or traditional healers to remove damage, roll out eggs, buy “magic” herbs, etc. Such actions only lead to a worsening of the patient’s condition and a delay in professional therapy. But exactly early diagnosis schizophrenia and timely treatment allows you to significantly improve the prognosis of the disease and get a high chance of complete recovery. What signs allow us to suspect the approach of the disease and identify a tendency to schizophrenia?

Signs of schizophrenic disorder in the pre-morbid stage

Schizophrenia is endogenous disease and is associated with biochemical disorders of the brain. And pathological processes in the brain cannot but affect a person’s behavior and thinking. During childhood or adolescence, a person who may later develop schizophrenia does not stand out much from other people. However, some signs are still worth paying attention to. Such children are usually a little withdrawn and may experience learning difficulties. You can notice some oddities in their behavior, for example, washing hands too often, unusual hobbies, coldness towards animals. Of course, the fact that a child is lagging behind in school and behaves withdrawn does not mean that he will necessarily suffer from schizophrenia in the future. It’s just that such a child or teenager should be monitored more carefully. It would also be a good idea to consult with a child psychologist.

Incubation period of the disease

As it gets worse pathological processes brain in schizophrenia, changes in the psyche and thinking become more pronounced. The incubation (prodromal) stage of the disease lasts on average about three years. Relatives do not always pay attention to gradually increasing oddities in the patient’s behavior, especially if this coincides with adolescence. Signs of the disease at this stage, which make it possible to understand whether a person has schizophrenia, may be as follows:

• strange behavioral reactions;
• desire for solitude, decreased initiative and energy level;
• changes in handwriting (for example, handwriting may become illegible or the slant of letters in handwriting may change);
• change in personality traits (a diligent and punctual teenager suddenly becomes absent-minded and careless);
• deterioration of creative, educational or working abilities;
• episodic simple hallucinatory or illusory manifestations;
• new extremely valuable hobbies, for example, philosophy, mysticism, religious ideas.

Graphologists believe that it is possible to understand whether there is a predisposition to schizophrenia by looking at a person’s handwriting.

Handwriting can say a lot about personality and thinking. However, illegible and intermittent handwriting in itself does not indicate schizophrenia; there must be other characteristic manifestations of the disease. If you begin to notice changes in handwriting or other signs in yourself or a loved one, you should consult a psychiatrist as soon as possible.

Self-diagnosis

Diagnosing schizophrenia is a difficult task even for experienced specialists. What can we say about trying to find out about the presence of such a complex disease on your own. An accurate diagnosis, determining the form of the disorder, can be made only after a series of examinations, differential diagnosis and conversation with a doctor. However, often people, due to a negative attitude towards psychiatry and stereotypical beliefs, are afraid to contact a psychiatrist, even if they discover that they have warning signs. Therefore, many are interested in how you can identify schizophrenia in yourself without the help of a psychiatrist? You can figure out if you have cause for concern about schizophrenia with some self-testing techniques.

To get started, try the following statements for yourself:

• It’s difficult for me to remember recent events, but I remember clearly what happened a long time ago;
• I get bored from most conversations and I’m not interested in making new acquaintances;
• I sometimes find it difficult to carry out daily duties;
• sometimes I have thoughts that I am acting against my will;
• It can be difficult for me to forget even minor grievances;
• I often can’t bring myself to leave the house for days;
• I am sometimes attacked by stupor or sudden excitement with aggression;
• My thoughts are sometimes foggy and confused;
• I am confident that I have unique abilities;
• those around me are trying to control my feelings and thoughts;
• I’m not interested in anything, and I don’t want to do anything;
• I feel that my family is under threat;
• for me my main adviser inner voice, I always consult with him;
• I am annoyed by close people for unknown reasons;
• I sometimes notice in myself a discrepancy between my expressed emotions and the surrounding environment and the emotions of other people;
• I often discover in myself an unreasonable feeling of fear;
• It’s difficult for me to show feelings of tenderness and love; I’m often self-absorbed.

Think about how true it would be for you to hear the following statements addressed to you from loved ones:

• you are not at all concerned about the suffering of other people or animals, your face does not reflect a feeling of compassion;
• you don’t look your interlocutor in the eyes;
• you sometimes talk out loud to yourself;
• you most like to spend time alone with yourself, avoid crowded places and attention from others;
• you hear something that is not really there, and what those around you do not hear;
• you began to speak indistinctly (stutter, lisp);
• your writing has become worse, your handwriting is somehow strange and illegible;
• you are considered a little eccentric, and strange expressions are noticed on your face;
• you talk to inanimate objects as if they were alive;
• you sometimes laugh or cry for no reason;
• you spend quite a lot of time on meaningless activities (you lie for hours, staring at the ceiling).

How to evaluate such testing? The more of the above statements apply to you, the higher your tendency and predisposition to schizophrenia and the more important it is for you to visit a specialist. Note that it is inclination! Because, even if absolutely all statements are identical to you, this does not mean that you have schizophrenic disorder. Only a psychiatrist can make a diagnosis.

You can also understand whether you have signs of schizophrenia using the visual test “Chaplin's Mask”, created by British neuropsychologist R. Gregory. Experience in observing patients shows that a characteristic feature of schizophrenia is a person’s immunity to visual illusions.

While taking this test, don't take your eyes off the picture. If everything is in order with your psyche, you will notice the optical illusion.

Diagnostics and MSE

Diagnostic process and ITU ( medical and social examination) in schizophrenia can take quite a long time, since the manifestations of the disease are very diverse. Differential diagnosis allows you to exclude mental, somatic and neurological pathologies that have symptoms similar to schizophrenia. However, put accurate diagnosis It is not always possible immediately even after differential diagnosis. How does the diagnostic process work? To begin with, the psychiatrist assesses the patient’s condition during a conversation. It reveals productive and negative symptoms, as well as the degree of cognitive impairment. Various tests are often used. For example, one can fairly accurately predict schizophrenia based on eye movements.

A person with this pathology cannot smoothly follow a slowly moving object with his eyes. Specific eye movements in schizophrenics are also observed when freely viewing pictures. Experienced doctor able to recognize signs of pathology in eye movements. It is also difficult for such people to keep their eyes still for a long time and fix their gaze on something. After the conversation, a series of examinations are carried out that allow us to assess the characteristics of the central nervous system and identify concomitant diseases, and endocrine disruptions. Studies such as EEG, MRI, TDS (special ultrasound scanning of cerebral vessels) make it possible to more accurately differential diagnosis, assess the severity of schizophrenia and select the most effective medications. MRI for schizophrenia is one of the effective ways to solve the problem - how to recognize schizophrenia even before its obvious signs appear and the person’s well-being deteriorates. It has been proven that changes in brain structures begin long before the symptoms of schizophrenia develop.

During the treatment process, at each stage of remission, an MSE of the patient is performed. If the exacerbation is protracted, MSE can be performed during the attack. During MSE, the duration and clinical form schizophrenia, dynamics and nature of negative disorders, type and characteristics of mental disorders. Also during the MSA process, it is important to assess how critical the patient is of his condition. During MSE, the stage of the disease, the nature of the leading syndrome and the quality of remissions are assessed. All this is necessary to determine the patient’s disability group based on the results of the MSA. The first group of disability is most often caused by continuous-current malignant form a disease that develops early and causes a rapid increase in negative disorders.