Schizophrenic dementia: symptoms and treatment. Schizophrenic dementia: classification, manifestations and psychotherapy Treatment of schizophrenic dementia

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A mental disorder such as schizophrenia has not been fully studied to this day, and therefore is surrounded by rumors and myths, which we will try to debunk in this article.

Myth 1. Schizophrenia is a split personality

For schizophrenia splitting is observed mental processes. The patient’s thoughts, emotions and behavior are illogical: loss loved one can cause him to have a fit of laughter, while he reacts to a joyful event by crying. Such a person is immersed in his inner world, who is far from modern realities: he is not interested in family, work, or appearance. He can love and hate at the same time, his life is poisoned day after day by obsessive voices that can come from within the patient himself or from outside (from a radio, a non-working telephone, a heating pipe, etc.). At the same time, voices or images put pressure on the patient, ordering him to perform certain actions.

And this is just the surface of the iceberg called schizophrenia. In some cases, the patient feels that the air is thick and opaque, and therefore it is simply impossible to breathe in it. Even own body is perceived as something mutilated, and sometimes hostile: a physically healthy patient with schizophrenia claims that he is missing one or another organ (arm, leg, liver), he is convinced that he is rotting from the inside. Moreover, he can be sure that intelligence agencies or alien beings have implanted a transmitter in his body to control his thoughts and actions. At the same time, neither relatives, nor doctors, nor the results of an x-ray examination can convince him of this. If a patient with schizophrenia refuses treatment, the result is often disastrous: loneliness, loss of family, work and goals in life, lack of livelihood, dementia and complete personality degradation.

With a split personality in one person several “I”s (or “ego states”) coexist, which replace each other. They can have different gender and age, intelligence and moral principles. When ego states change, memory loss is often observed, that is, the patient may not remember what one of his subpersonalities did. Simply put, a person suffering from a split personality lives in parallel realities, communicates with absolutely different people, behaves diametrically opposite.

Conclusion: By split personality in schizophrenia we mean the splitting of unified mental processes, while with true split personality independent integrated ego states are formed. At the same time, in schizophrenia, the possibility of developing a split personality cannot be ruled out.

Myth 2. Schizophrenia is a dangerous disease for others

The behavior of patients with schizophrenia may be inappropriate and unpredictable, but they rarely show aggression and violence towards others. Often people with this diagnosis strive for solitude and self-isolation; they are characterized by alienation.

Schizophrenia is more dangerous not for others, but for the people themselves suffering from this disorder. Suicide is one of the most common reasons for the death of patients with schizophrenia in early age. And the culprit is the loss of work and prospects, fear of the consequences of one’s condition and loneliness. Sometimes it is in suicide that people with schizophrenia see liberation from those voices and images that poison their lives every day.

And yet we should not exclude the fact that with schizophrenia a person can show aggression, especially during periods of prolonged depression and with the abuse of alcohol, drugs and other psychotropic drugs. In general, hostility, anger and aggression are more characteristic of patients with visual and auditory hallucinations, provided that audible voices and visible images threaten, put pressure on a person, order him to commit a crime. To drown out the intrusive voice and get rid of it, people suffering from schizophrenia are even ready to kill. To be fair, we note that the percentage of patients with schizophrenia who are prone to aggression and violence is extremely low.

Myth 3. Schizophrenia develops as a result of poor upbringing

"All problems come from childhood!" - a favorite phrase of psychologists and psychiatrists. Of course, upbringing is the foundation on which the child’s entire future life will be built. And not only his happiness and well-being, but also his mental health depends on what this foundation will be.

But! Only one thing bad Education cannot cause a child to develop a disorder such as schizophrenia. This requires more significant factors, among which the main one is considered to be a genetic predisposition to schizophrenia. At the same time, you should not give up on a child whose one of the parents has schizophrenia, because such families often give birth to mentally absolutely healthy children. And remember that in the presence of “bad” heredity, an unfavorable family atmosphere and constant scandals can provoke the early debut of this disorder in a child.

Important! Many believe that a mother or father diagnosed with schizophrenia cannot properly raise their child, instill in him the standards of morality and morality by which any civilized society lives. But this is not true at all! Adequate treatment, care and support from relatives help people with schizophrenia lead a normal life: love, work, have friends, create happy families and raise wonderful children.

Myth 4. Schizophrenia is always inherited

It's no secret that schizophrenia is inherited, but this does not mean that if the mother or father has this diagnosis, then the child has no chance of growing up absolutely mentally healthy.

Psychotherapists say that if one of the parents suffers from schizophrenia, then the risk of developing this disease in the child is about 10–15%, while in children whose mother and father suffer from this mental disorder, this risk increases to 40–50%.

It should be remembered that 1% of patients with schizophrenia did not have relatives with this mental disorder, that is, they did not have “bad” heredity.

Myth 5. Drugs cause schizophrenia

It is not entirely correct or correct to talk about drugs as a cause of the development of schizophrenia. Yes, drugs are evil. Yes, they can cause visual and auditory hallucinations. Yes, they destroy the psyche and cause personality degradation. But! There is no evidence that drugs provoke the development of schizophrenia in a mentally healthy person.

However, we should not forget that if there is genetic predisposition to schizophrenia, drugs can become one of the triggers for the development of this mental disorder.

Unfortunately, not all patients with schizophrenia manage to muster the will to concentrate on treating their illness. Many people prefer the use of narcotic drugs (marijuana, amphetamines, LSD, spice and other psychotropic stimulants) to competent treatment, which only accelerates the process of personality degradation and aggravates the already vivid symptoms of schizophrenia.

Myth 6: Dementia is the main symptom of schizophrenia

This is not entirely true, especially in cases where schizophrenia is diagnosed early stages, and the patient himself adheres to all the instructions of his treating psychiatrist and takes medications.

In general, dementia in schizophrenia has certain characteristics, since the intellect initially practically does not suffer. Even memory is retained for a long time. But! The thinking of a person suffering from schizophrenia is characterized by passivity, abstraction and whimsicality. Apathy and lack of purpose in life leads to the fact that the stock of knowledge and practical skills is not used for its intended purpose, and over time it is completely lost. The patient degrades as a person.

In severe cases of schizophrenia, patients can:

• do not get out of bed for weeks or months (although their motor functions are not impaired),
• refuse to eat on their own (but will eat without objection if they are spoon-fed),
• do not respond to the questions of others (for such a patient an interlocutor means no more than a silent chair or table),
• do not control the acts of urination and defecation, while neurotic disorders may be completely absent.

Myth 7. Many people with schizophrenia are geniuses

Plato also said that genius and madness are sisters. And there is some truth in this, because many great personalities had a history of mental disorders.

For example, Van Gogh He was tormented by visual and auditory hallucinations, provoking aggression and suicidal thoughts in him. In addition, he was prone to bouts of masochism.

Friedrich Nietzsche was simply obsessed with the idea of ​​a superman. He himself suffered from nuclear mosaic schizophrenia with delusions of grandeur. He has undergone treatment more than once psychiatric hospitals, where during periods of enlightenment he continued to write his imperishable philosophical works.

Jean-Jacques Rousseau I saw everything as a conspiracy against myself. Paranoid schizophrenia, aggravated by the mania of persecution, made a lonely wanderer out of an outstanding philosopher and writer.

Nikolay Gogol suffered from schizophrenia with episodes of psychosis. In addition, he believed that all the organs in his body were in the wrong location.

So what connects genius and schizophrenia? Unusual perception of the world? The ability to create strange associations? Extraordinary thinking? Or maybe a certain gene that links schizophrenia and creative potential? There are more questions than answers. But one thing is clear: the world created by geniuses suffering from mental disorders ultimately destroys them.

Myth 8. Schizophrenia can only be treated in psychiatric hospitals

Achievements modern medicine allow schizophrenia to be treated in most cases without long-term round-the-clock hospitalization in a psychiatric clinic. The patient can visit day hospital or get treatment at home.

Patients with acute course schizophrenia, which can cause harm to themselves or others.

After removal acute condition, patients diagnosed with schizophrenia are discharged home, where they undergo rehabilitation under the supervision of family and friends, social workers, as well as the supervising psychiatrist.

Myth 9. People with schizophrenia cannot work

With schizophrenia, it is extremely important that a person does not lose social connections. And in this regard professional activity becomes an excellent help in overcoming self-doubt, isolation and alienation. Work helps not only to adapt to society, but also to assert oneself (even with such a diagnosis, one can achieve a lot in the professional field). But still, there are a number of professions that are not recommended for patients with schizophrenia.

Firstly, this is any night shift work . The fact is that disruption of cyclic biorhythms can lead to a deterioration in the condition of a patient with schizophrenia.

Secondly, this work activity associated with constant psycho-emotional pressure and tension . Conflicts at work can trigger a relapse of the disease. It is also important that the patient does not have disagreements with the team in which he works.

Thirdly, patients with schizophrenia are contraindicated in any work involving danger, i.e. electricity, large machinery, fire, gas .

Fourthly, patients with such a diagnosis contact with weapons is prohibited , let alone own it. Therefore, you can forget about a military career or work in armed security.

Myth 10. Schizophrenia can be cured once and for all

To date, there is no medicine or treatment that can completely cure schizophrenia. But this does not mean that the diagnosis of schizophrenia is a death sentence. If you do not delay the diagnosis and treatment of this chronic disorder, if you strictly follow all the doctor’s instructions and take medications to relieve the manifestations of schizophrenia, you can achieve a stable long-term remission.

To achieve stable remission is the main task of the doctor and the patient with such a disorder as schizophrenia. And you can’t do without taking medications, no matter what they tell you. traditional healers, offering rubbing and taking herbal decoctions to get rid of this mental disorder once and for all. Do not waste precious time, seek help from qualified psychiatrists, enlist the support of family and friends, and believe in yourself, only then will you be able to achieve positive results in the treatment of schizophrenia.

According to the classification of O.V. Kerbikov, it belongs to dementia, in which there are no deep organic changes. According to I.F. Sluchevsky, it belongs to transient dementia. On this occasion he wrote:

Patients with schizophrenia may exhibit profound dementia for many years, and then, unexpectedly for those around them, including doctors, discover relatively well-preserved intellect, memory and the sensory sphere.

There was a debate whether dementia in schizophrenia could be considered dementia itself. Thus, Kurt Schneider believed that in these cases, strictly speaking, dementia is not observed, since “general judgments and memory and other things that can be classified as intelligence do not undergo direct changes,” but only some disturbances in thinking are observed. A.K. Anufriev noted that a patient suffering from schizophrenia may simultaneously seem during a conversation with him to be both feeble-minded and not feeble-minded, and that the term “schizophrenic dementia” is quite justifiably put in quotation marks. According to G.V. Grule, intellectual disability in schizophrenia depends on the characteristics of mental activity that do not directly affect intelligence and are volitional disorders apato-abulia type and thinking disorders. Therefore, we cannot talk about changes in intelligence in schizophrenia as classic dementia. With schizophrenic dementia, it is not the intellect that suffers, but the ability to use it. As the same G.V. Grule said:

The car is intact, but is not fully or sufficiently maintained.

Other authors compare intelligence in schizophrenia to a bookcase full of interesting, intelligent and useful books to which the key has been lost. According to M.I. Weisfeld (1936), schizophrenic dementia is caused by “distraction” (delusions and hallucinations), “insufficient activity” of the individual before the illness, “the influence of acute psychotic conditions” and “lack of exercise.” On the latter occasion, he quotes the words of the great Renaissance figure Leonardo da Vinci, who argued that a razor becomes covered with rust through disuse:

the same thing happens to those minds that, having stopped exercising, indulge in idleness. Such, like the above-mentioned razor, lose their cutting subtlety and the rust of ignorance corrodes their appearance.

Criticizing the idea of ​​the outcome of mental illness in dementia, N. N. Pukhovsky notes that the phenomena attributed to “schizophrenic dementia” are closely related to toxic-allergic complications with inadequate tactics of active treatment of psychoses (including neuroleptic, ECT, insulin comatose therapy, pyrotherapy), with remnants of the system of constraint in psychiatric hospitals and the phenomena of hospitalism, desocialization, coercion, separation and isolation, and everyday discomfort. He also associates “schizophrenic dementia” with the defense mechanism of regression and repression (parapraxis).

Nevertheless, the discrepancy between intellectual reactions and stimuli indicates the presence of dementia in patients with schizophrenia, albeit in a unique version.

Story

Particular dementia in patients with schizophrenia, 4 years after E. Bleuler created the very concept of the disease, was described by the Russian psychiatrist A. N. Bernstein in 1912 in “Clinical Lectures on Mental Illnesses.”

Classification

According to A. O. Edelshtein’s classification, based on the degree of personality disintegration, the following are distinguished:

1. Syndrome of “apathetic” dementia (“dementia of impulses”);
2. “Organic” type of dementia - by type organic disease, for example, like Alzheimer's disease;
3. Ruining syndrome with the onset of insanity;
4. “Personal disintegration” syndrome.

Pathogenesis

The pathogenesis of schizophrenic dementia, like schizophrenia itself, is not fully known. However, some aspects of it are described. The Austrian psychiatrist Joseph Berze in 1914 considered schizophrenic dementia to be a “hypotension of consciousness.” It is noteworthy that later many other scientists agreed with him: major researchers of schizophrenia K. Schneider, A. S. Kronfeld and O. K. E. Bumke. The Soviet physiologist I.P. Pavlov also considered schizophrenia to be a chronic hypnoid state. However, this is not enough to understand the pathogenesis of schizophrenic dementia. In schizophrenia, while the elements of intelligence are preserved, its structure is disrupted. In this regard, the main clinical picture of the condition appears. According to V. A. Vnukov, expressed back in 1934, the basis of schizophrenic dementia is splitting of intellect and perceptions, paralogical thinking and flattened affect.

Clinical picture

Perceptual disorders

Profound disturbances in perception in schizophrenia, primarily symbolism, derealization and depersonalization, have a negative impact on the intellect.

Thought disorders

Thinking in schizophrenic dementia is ataxic, with elements of pretentiousness, symbolism, formality, mannerism, mosaic. At one time, E. Kraepelin, while studying “dementia praecox,” noted the “driving around,” “sliding,” “pulling apart” of thoughts. So-called ataxic thinking appears, externally manifested by speech disorders, often in the form of schizophasia, when sentences are grammatically correct, but their content is meaningless, slippage from the topic occurs, neologisms, contaminations arise, symbolic understanding occurs, perseveration, embolophrasia, paralogicality, combination of incongruous things and separation indivisible.

Memory disorders

Memory in schizophrenic dementia, as in schizophrenia in general, long time saved. Such patients are well oriented in their own personality, space and time. According to E. Bleuler, the phenomenon when patients with schizophrenia, along with psychotic ones, have preserved some aspects of intelligence, is figuratively called “double-entry bookkeeping.”

Forecast

Since schizophrenia is a chronic and progressive disease, the prognosis for recovery from such dementia, if it has already occurred, is usually questionable. However, since this dementia is transient, if the course of the disease itself can be stopped, the prognosis can be relatively favorable. In other cases, an extremely unfavorable outcome is possible. There occurs either an extreme increase in negative symptoms in the form of complete apathy, abulia and autism, which manifests itself in absolute indifference, untidiness, disintegration of social connections and lack of speech, or with elements of the former clinical form schizophrenia: defect hebephrenia, residual catatonia, rudiments of delusions in the paranoid form. However, the prognosis for life is favorable, and for work ability it is relatively favorable when successful treatment.

Literature

• O. V. Kerbikov, M. V. Korkina, R. A. Nadzharov, A. V. Snezhnevsky. Psychiatry. - 2nd, revised. - Moscow: Medicine, 1968. - 448 p. - 75,000 copies;
• O. K. Naprenko, I. J. Vlokh, O. Z. Golubkov. Psychiatry = Psychiatry / Ed. O. K. Naprenko. - Kiev: Zdorovya, 2001. - P. 325-326. - 584 pp. - 5000 copies - ISBN 5-311-01239-0.;
• Yu. A. Antropov, A. Yu. Antropov, N. G. Neznanov. Intelligence and its pathology // Fundamentals of diagnostics of mental disorders. - 2nd, revised. - Moscow: GEOTAR-Media, 2010. - P. 257. - 448 p. - 1500 copies. - ISBN 978-5-9704-1292-3.;
• N. N. Pukhovsky. Therapy of mental disorders, or Other psychiatry: A textbook for higher education students educational institutions. - Moscow: Academic Project, 2003. - 240 p. - (Gaudeamus). - ISBN 5-8291-0224-2.

According to the classification of O.V. Kerbikov, it belongs to dementia, in which there are no deep organic changes. According to I.F. Sluchevsky, it belongs to transient dementia. On this occasion he wrote:

Patients with schizophrenia may exhibit profound dementia for many years, and then, unexpectedly for those around them, including doctors, discover relatively well-preserved intellect, memory and the sensory sphere.

There was a debate whether dementia in schizophrenia could be considered dementia itself. Thus, Kurt Schneider believed that in these cases, strictly speaking, dementia is not observed, since “general judgments and memory and other things that can be classified as intelligence do not undergo direct changes,” but only some disturbances in thinking are observed. A.K. Anufriev noted that a patient suffering from schizophrenia may simultaneously seem during a conversation with him to be both feeble-minded and not feeble-minded, and that the term “schizophrenic dementia” is quite justifiably put in quotation marks. According to G.V. Grule, intellectual impairment in schizophrenia depends on the characteristics of mental activity that do not directly affect intelligence and are volitional disorders such as apatho-abulia and thinking disorders. Therefore, we cannot talk about changes in intelligence in schizophrenia as classic dementia. With schizophrenic dementia, it is not the intellect that suffers, but the ability to use it. As the same G.V. Grule said:

The car is intact, but is not fully or sufficiently maintained.

Other authors compare intelligence in schizophrenia to a bookcase full of interesting, intelligent and useful books to which the key has been lost. According to M.I. Weisfeld (1936), schizophrenic dementia is caused by “distraction” (delusions and hallucinations), “insufficient activity” of the individual before the illness, “the influence of acute psychotic conditions” and “lack of exercise.” On the latter occasion, he quotes the words of the great Renaissance figure Leonardo da Vinci, who argued that a razor becomes covered with rust through disuse:

the same thing happens to those minds that, having stopped exercising, indulge in idleness. Such, like the above-mentioned razor, lose their cutting subtlety and the rust of ignorance corrodes their appearance.

Criticizing the idea of ​​the outcome of mental illness in dementia, N. N. Pukhovsky notes that the phenomena attributed to “schizophrenic dementia” are closely related to toxic-allergic complications with inadequate tactics of active treatment of psychoses (including neuroleptic, ECT, insulin comatose therapy, pyrotherapy), with remnants of the system of constraint in psychiatric hospitals and the phenomena of hospitalism, desocialization, coercion, separation and isolation, and everyday discomfort. He also associates “schizophrenic dementia” with the defense mechanism of regression and repression (parapraxis).

Nevertheless, the discrepancy between intellectual reactions and stimuli indicates the presence of dementia in patients with schizophrenia, albeit in a unique version.

Story

Particular dementia in patients with schizophrenia, 4 years after E. Bleuler created the very concept of the disease, was described by the Russian psychiatrist A. N. Bernstein in 1912 in “Clinical Lectures on Mental Illnesses.”

Classification

According to A. O. Edelshtein’s classification, based on the degree of personality disintegration, the following are distinguished:

1. Syndrome of “apathetic” dementia (“dementia of impulses”);
2. “Organic” type of dementia - according to the type of organic disease, for example, Alzheimer's disease;
3. Ruining syndrome with the onset of insanity;
4. “Personal disintegration” syndrome.

Pathogenesis

The pathogenesis of schizophrenic dementia, like schizophrenia itself, is not fully known. However, some aspects of it are described. The Austrian psychiatrist Joseph Berze in 1914 considered schizophrenic dementia to be a “hypotension of consciousness.” It is noteworthy that later many other scientists agreed with him: major researchers of schizophrenia K. Schneider, A. S. Kronfeld and O. K. E. Bumke. The Soviet physiologist I.P. Pavlov also considered schizophrenia to be a chronic hypnoid state. However, this is not enough to understand the pathogenesis of schizophrenic dementia. In schizophrenia, while the elements of intelligence are preserved, its structure is disrupted. In this regard, the main clinical picture of the condition appears. According to V. A. Vnukov, expressed back in 1934, the basis of schizophrenic dementia is splitting of intellect and perceptions, paralogical thinking and flattened affect.

Clinical picture

Perceptual disorders

Profound disturbances in perception in schizophrenia, primarily symbolism, derealization and depersonalization, have a negative impact on the intellect.

Thought disorders

Thinking in schizophrenic dementia is ataxic, with elements of pretentiousness, symbolism, formality, mannerism, mosaic. At one time, E. Kraepelin, while studying “dementia praecox,” noted the “driving around,” “sliding,” “pulling apart” of thoughts. So-called ataxic thinking appears, externally manifested by speech disorders, often in the form of schizophasia, when sentences are grammatically correct, but their content is meaningless, slippage from the topic occurs, neologisms, contaminations arise, symbolic understanding occurs, perseveration, embolophrasia, paralogicality, combination of incongruous things and separation indivisible.

Memory disorders

Memory in schizophrenic dementia, as in schizophrenia in general, is preserved for a long time. Such patients are well oriented in their own personality, space and time. According to E. Bleuler, the phenomenon when patients with schizophrenia, along with psychotic ones, have preserved some aspects of intelligence, is figuratively called “double-entry bookkeeping.”

Forecast

Since schizophrenia is a chronic and progressive disease, the prognosis for recovery from such dementia, if it has already occurred, is usually questionable. However, since this dementia is transient, if the course of the disease itself can be stopped, the prognosis can be relatively favorable. In other cases, an extremely unfavorable outcome is possible. Either an extreme increase in negative symptoms occurs in the form of complete apathy, abulia and autism, which manifests itself in absolute indifference, untidiness, disintegration of social connections and lack of speech, or with elements of the previous clinical form of schizophrenia: defect hebephrenia, residual catatonia, rudiments of delusions in the paranoid form. However, the prognosis for life is favorable, and for work ability it is relatively favorable with successful treatment.

Literature

• O. V. Kerbikov, M. V. Korkina, R. A. Nadzharov, A. V. Snezhnevsky. Psychiatry. - 2nd, revised. - Moscow: Medicine, 1968. - 448 p. - 75,000 copies;
• O. K. Naprenko, I. J. Vlokh, O. Z. Golubkov. Psychiatry = Psychiatry / Ed. O. K. Naprenko. - Kiev: Zdorovya, 2001. - P. 325-326. - 584 pp. - 5000 copies - ISBN 5-311-01239-0.;
• Yu. A. Antropov, A. Yu. Antropov, N. G. Neznanov. Intelligence and its pathology // Fundamentals of diagnostics of mental disorders. - 2nd, revised. - Moscow: GEOTAR-Media, 2010. - P. 257. - 448 p. - 1500 copies. - ISBN 978-5-9704-1292-3.;
• N. N. Pukhovsky. Therapy of mental disorders, or Other psychiatry: A textbook for students of higher educational institutions. - Moscow: Academic Project, 2003. - 240 p. - (Gaudeamus). - ISBN 5-8291-0224-2.

Psychogenic false dementia (pseudo-dementia, Wernicke C., 1900; Stertz G., 1910).

This type of dementia is one of the clinical forms of hysterical psychoses. The conditions for the occurrence of pseudodementia are acute psychotrauma and the presence of mild premorbid mental disability (G.A. Obukhov). According to N.I. Felinskaya, most often inferiority is characterized by features of hysterical or epileptoid, less often - schizoid or cycloid accentuation or psychopathy.

Phenomenologically, pseudodementia refers to a transient type of dementia. Symptoms occur acutely, usually against a background of depressed mood and anxiety. Orientation is lost, patients experience a feeling of fear and anxiety: they tremble, look around in fear, huddle in a corner, sometimes silently cry. Their statements often contain elements of paranoid experiences, also colored by an affect of fear (“they will come, kill, slaughter, quarter…”). Patients experience bright hypnagogic hallucinations frightening in nature (they see “scary faces with knives in their teeth”, angry dogs, devils, hear barking dogs, footsteps, feel that they are being strangled, bitten, etc.). Then the clinical manifestations become more specific. In the behavior of patients, confusion comes to the fore, which manifests itself in the whole appearance, gestures, in a characteristic lack of understanding of what is happening, in a frightened and anxious gaze that does not fixate on objects and faces. Patients stare, try to climb the wall, bump into objects, pull socks on their hands, do not know how to sit on a chair, pick up certain objects and look at them in surprise, crawl on all fours on the floor, etc.

Left to their own devices, patients lie on the bed or sit, not communicating with anyone. When contacting patients, they only answer questions and carry out actions as directed. At the same time, attention is drawn to the contrast between the usual lethargy of patients and fussiness and haste while performing tasks.

The symptom of passing speech, passing speech is very characteristic (Ganser S.J.M., 1898). Its essence lies in a certain correspondence between the content of the incorrect answer and the meaning of the question posed. Patients incorrectly name the time of year or year. The floor is called the table, and the table is called the floor. The counting is done slowly, using fingers, moving lips 5+5=8, 7-3=5. In response to the question of how many fingers there are on their hands, patients often begin to look at the splayed fingers, count them with errors, or answer “I don’t know.”

In some cases, the answers are similar to amnestic aphasia; when asked to name this or that object, the patient describes their function (“glasses - to look”, “key - to open the door”). Patients respond with long pauses and slowly. You have to repeat the questions. The answers may be of the nature of echolalia: when asked how old you are, the patient answers “how old are you.” Phrases are sometimes constructed ungrammatically. The content of the speech is poor and unreliable. Sometimes hysterical phantasms are observed.

No less characteristic are “mimic actions” (“motor pseudodementia” - G. Stertz), when patients, when asked to touch their nose with a finger, take themselves by the ear; when asked to show their teeth, they open their mouth with their fingers. In this case, helpless fussiness, incomplete attempts at certain actions, and lack of coordination of movements are typical. This is similar to “apraxia”, but it is pseudoapraxia (G.A. Obukhov).

Clinical picture pseudodementia usually includes elements of puerility, manifested in capriciousness, in naivety of answers, in children's intonations of speech, in children's games with sticks, with balls made of bread, etc. Symptoms of “running wild” may be observed: patients eat with their tongue (lapped) from a plate, crawl on the floor on all fours, and make sounds reminiscent of a dog barking.

In some cases, manifestations of pseudodementia appear against the background of severe depression: patients are motorally inhibited, often cry, and their responses sound hopeless and melancholy.

Depression and asthenic-depressive manifestations are observed in most patients at the exit from a psychotic state. At the same time, the symptoms of pseudodementia gradually smooth out: confusion and anxiety decrease, orientation in the place and then in the situation appears. The answers are becoming more correct, patients are becoming more accessible.

The acute psychotic period is usually completely amnesic, but some vague memories may remain, most often images of hypnagogic hallucinations are remembered.

Pseudo-dementia is also observed in the structure of Ganser's syndrome (Ganser S.J.M., 1898).

Schizophrenic dementia phenomenologically belongs to the transient type. I.F. Sluchevsky, justifying the identification of transient dementia, wrote: “patients with schizophrenia can exhibit deep dementia for many years, and then, unexpectedly for those around them, including doctors, discover relatively well-preserved intellect, memory and the sensory sphere” (1959). In this regard, the views of Gruhle (H.W. Gruhle, 1929) are of interest, according to whom intellectual disability in schizophrenia depends on mental characteristics that lie outside the intellect: a violation of initiative, resourcefulness, ingenuity, perseverance, determination, etc. Grule and Berze argue that a person with schizophrenia “possesses the instrument of formal intellect until the end of his days, but for a long time he cannot use this instrument, since he has no interest in using it” (1929). In their opinion, we should rather talk about a special different manner of thinking in patients with schizophrenia, so unusual that the thought of dementia appears. A.N. wrote about the incomprehensibility and alienness of mental structures, consciousness and logic of patients with schizophrenia to ordinary (normal) people long before Grule. Bernstein (1912) in Clinical Lectures on Mental Illnesses.

According to M. Weisfeld (1936), intellectual deficiency in schizophrenia is caused by “distraction” (delusional experiences, hallucinations, etc.), “insufficient activity” (a property of a premorbid personality), “the influence of acute psychotic states” and “lack of exercise” ( M. Weisfeld cites the judgments of Leonardo da Vinci on this matter, who, referring to the fact that a razor becomes covered with rust through disuse, notes: “the same happens to those minds that, having stopped exercising, indulge in idleness. Such as the above-mentioned razor , lose their cutting subtlety and the rust of ignorance eats away their appearance." However, incorrect behavior, absurdity in actions, inadequacy of intellectual reactions, their inconsistency with social stimuli in patients with schizophrenia indicate the presence of dementia. An important sign schizophrenic dementia Berze (Berze J., 1914) considered “hypotonia of consciousness,” which a number of authors compare with the state when falling asleep (K. Schneider, A.S. Kronfeld, O. Bumke, etc.), which is very close to the pathophysiological interpretations of I .P. Pavlov, who considered schizophrenia to be a chronic hypnoid state. However, this is not enough to understand the clinical structure of schizophrenic dementia. As numerous studies have shown, in schizophrenia there is a disruption in the systemic functioning of the intellect while its individual elements are preserved. In particular, this is manifested in the asynchrony of thinking processes, which acquires a special character of pretentiousness, symbolism, formality, mannerism, mosaic. The cognitive apparatus is preserved, but associative connections are significantly modified, narrowed and disordered. Disunity, “piece-like” work of the intellect and individual apparatuses of the “I”, fragmentation in perceptions and ideas, mosaic of experiences, along with the paralogical structure and “affective attenuation of the personality” (Vnukov V.A., 1934) form the basis of schizophrenic dementia.

It should be added that in patients with schizophrenia, orientation in time, place, surroundings, as well as basic memory processes, are satisfactorily preserved for a long time. Only their memorization turns out to be worse due to a drop in interest and impaired ability to concentrate. E. Bleuler (1911) refers to the combination of psychotic symptoms with individual normal intellectual abilities in schizophrenia as manifestations of “double-entry bookkeeping.”

A destructive influence on intellectual activity is exerted by perverted, incorrect, symbolic perception, the phenomena of derealization and depersonalization, and most importantly, disturbances in thinking caused by the “driving around”, “sliding”, “pulling apart” of thoughts described by Kraepelin. Disconnection occurs, disruption of the flow of associations, loss of individual links of the associative chain; during the associative process, extraneous ideas and ideas burst in atactically (embolically), which is due to the absence or lowering of goals, a decline in the processes of concentration and interest, and a violation of the harmonious relationship between cognitive processes and emotional response . This determines the features of ataxic speech confusion, characterized by the presence of the correct grammatical structure of phrases with a violation of the semantic content in the form of distorted thought formation, “slipping”, “driving around”, pseudo-concepts and neologisms, contamination, symbolic understanding and interpretation, “substitution”, described by B.Ya . Pervomaisky (1971) of the phenomenon of “displacement” (temporary asynchrony), perseverations, emboli, absurd answers, paradoxical conclusions and statements, combination of the incongruous and separation of the indivisible. In the structure of schizophrenic dementia, schizophasia may occur, which is a degree of ataxic speech confusion in which intellectual communication is impossible. Speech in these cases is devoid of emotional expressiveness, monotonous, and sometimes takes on the character of indistinct, meaningless muttering. The voice is usually quiet, but at times there may be loud cries.

As the disease progresses, dementia increases, which manifests itself in an increasingly sharp decline in intellectual productivity, intelligence, loss of a critical attitude to the environment and to one’s condition, and an increase in absent-mindedness, apathy, autism, and associative ataxia.

With deep schizophrenic dementia, patients sit motionless or lie in bed, completely indifferent to what is happening around them and to their own needs, not even showing purely physiological desires: they are unkempt, they have to be spoon-fed. All social and personal connections disintegrate, verbal communication with patients turns out to be impossible. For some time, some familiar gestures are retained.

Dementia can be of a simple nature, in which productive psychopathological symptoms are reduced and more or less pronounced intellectual failure comes to the fore, including not only a decrease in the level of cognitive processes, but also an impoverishment of the intellectual thesaurus.

A.O. Edelstein (1938) proposed to distinguish variants of the initial states of schizophrenia depending on the degree of personality destruction: the syndrome of “apathetic” dementia (“dementia of impulses”); “organic” type of dementia, which is characterized by a disorder of criticism, primitiveness and banality of judgments, poverty of thinking, mental exhaustion; “ruining” syndrome – a total collapse of the intellect and personality while maintaining only lower mental functions; “personal disintegration” syndrome.

The initial conditions in schizophrenia can be of the nature of dementia, in which some traces of the clinical form are preserved: hebephrenia (defect hebephrenia), catatonic manifestations (negativism, stereotypies), some extremely monotonous, stereotypical delusional statements devoid of emotional coloring.

V. Kerbikova, it belongs to dementia, in which there are no deep organic changes. According to I.F. Sluchevsky, it belongs to transient dementia. On this occasion he wrote:

There was a debate whether dementia in schizophrenia could be considered dementia itself. Thus, Kurt Schneider believed that in these cases, strictly speaking, dementia is not observed, since “general judgments and memory and other things that can be classified as intelligence do not undergo direct changes,” but only some disturbances in thinking are observed. A.K. Anufriev noted that a patient suffering from schizophrenia may simultaneously seem during a conversation with him to be both feeble-minded and not feeble-minded, and that the term “schizophrenic dementia” is quite justifiably put in quotation marks. According to G.V. Grule (German) Russian. , intellectual disorder in schizophrenia depends on the characteristics of mental activity that do not directly affect intelligence and are volitional disorders such as apato-abulia and thinking disorders. Therefore, we cannot talk about changes in intelligence in schizophrenia as classic dementia. With schizophrenic dementia, it is not the intellect that suffers, but the ability to use it. As the same G.V. Grule said:

Other authors compare intelligence in schizophrenia to a bookcase full of interesting, smart and useful books, to which the key has been lost. According to M.I. Weisfeld (1936), schizophrenic dementia is caused by “distraction” (delusions and hallucinations), “insufficient activity” of the individual before the illness, “the influence of acute psychotic conditions” and “lack of exercise.” On the latter occasion, he quotes the words of the great Renaissance figure Leonardo da Vinci, who argued that a razor becomes covered with rust through disuse:

Criticizing the idea of ​​the outcome of mental illness in dementia, N. N. Pukhovsky notes that the phenomena attributed to “schizophrenic dementia” are closely related to toxic-allergic complications with inadequate tactics of active treatment of psychoses (including neuroleptic, ECT, insulin comatose therapy, pyrotherapy), with remnants of the system of constraint in psychiatric hospitals and the phenomena of hospitalism, desocialization, coercion, separation and isolation, and everyday discomfort. He also associates "schizophrenic dementia" with the defense mechanism of regression and repression (parapraxis).

Nevertheless, the discrepancy between intellectual reactions and stimuli indicates the presence of dementia in patients with schizophrenia, albeit in a unique version.

Particular dementia in patients with schizophrenia, 4 years after E. Bleuler created the very concept of the disease, was described by the Russian psychiatrist A. N. Bernstein in 1912 in “Clinical Lectures on Mental Illnesses”.

According to A. O. Edelshtein’s classification, based on the degree of personality disintegration, the following are distinguished:

1. Syndrome of "apathetic" dementia ("dementia of impulses");
2. “Organic” type of dementia - according to the type of organic disease, for example, Alzheimer's disease;
3. Ruining syndrome with the onset of insanity;
4. “Personal disintegration” syndrome.

The pathogenesis of schizophrenic dementia, like schizophrenia itself, is not fully known. However, some aspects of it are described. The Austrian psychiatrist Joseph Berze in 1914 considered schizophrenic dementia to be a “hypotension of consciousness.” It is noteworthy that later many other scientists agreed with him: major researchers of schizophrenia K. Schneider, A. S. Kronfeld and O. K. E. Bumke (English) Russian. . The Soviet physiologist I.P. Pavlov also considered schizophrenia to be a chronic hypnoid state. However, this is not enough to understand the pathogenesis of schizophrenic dementia. In schizophrenia, while the elements of intelligence are preserved, its structure is disrupted. In this regard, the main clinical picture of the condition appears. According to V. A. Vnukov, expressed back in 1934, the basis of schizophrenic dementia is splitting of intellect and perceptions, paralogical thinking and flattened affect.

Perceptual disorders

Profound disturbances in perception in schizophrenia, primarily symbolism, derealization and depersonalization, have a negative impact on the intellect.

Thought disorders

Thinking in schizophrenic dementia is ataxic, with elements of pretentiousness, symbolism, formality, mannerism, mosaic. At one time, even E. Kraepelin, exploring “dementia praecox”, noted the “driving around”, “sliding”, “pulling apart” of thoughts. So-called ataxic thinking appears, externally manifested by speech disorders, often in the form of schizophasia, when sentences are grammatically correct, but their content is meaningless, slippage from the topic occurs, neologisms, contaminations arise, symbolic understanding occurs, perseveration, embolophrasia, paralogicality, combination of incongruous things and separation indivisible.

Memory disorders

Memory in schizophrenic dementia, as in schizophrenia in general, is preserved for a long time. Such patients are well oriented in their own personality, space and time. According to E. Bleuler, the phenomenon when patients with schizophrenia, along with psychotic ones, have preserved some aspects of intelligence, is figuratively called “double-entry bookkeeping.”

Since schizophrenia is a chronic and progressive disease, the prognosis for recovery from such dementia, if it has already occurred, is usually questionable. However, since this dementia is transient, if the course of the disease itself can be stopped, the prognosis can be relatively favorable. In other cases, an extremely unfavorable outcome is possible. Either an extreme increase in negative symptoms occurs in the form of complete apathy, abulia and autism, which manifests itself in absolute indifference, untidiness, disintegration of social connections and lack of speech, or with elements of the previous clinical form of schizophrenia: defect hebephrenia, residual catatonia, rudiments of delusions in the paranoid form. However, the prognosis for life is favorable, and for work ability it is relatively favorable with successful treatment.

Symptoms and treatment of dementia in schizophrenia

An irreversible change in the psyche is called dementia. A variety of comorbidities give dementia its unique characteristics. Schizophrenic dementia is marked by a lack of intelligence provoked by emotional breakdowns.

This type of dementia is temporary. A person who was considered sick for many years suddenly begins to communicate, showing the full presence of intelligence.

Schizophrenic dementia: what is this disease?

Dementia in schizophrenia is not characterized by deep organic changes. Acquired knowledge, professional skills and intelligence are retained by the subject. But he doesn't always know how to use them.

Intellectual disability, according to Grule, depends on the individual. Researchers Grule and Bertse discovered that the patient retains his memory, emotions, and acquired knowledge throughout his life. But he doesn’t use them because he loses interest in it.

In schizophrenia, qualities that lie outside the boundaries of intelligence are violated:

For those suffering from schizophrenia non-standard way thinking that makes doctors think about dementia. Bernstein wrote about incomprehensible mental constructs that are alien to normal people even before Grule, at the beginning of the twentieth century.

Stages of development and life expectancy

It is believed that schizophrenic dementia, once it appears, can become chronic. But, dementia in this case can also be temporary. Therefore, if it is possible to stop the course of chronic schizophrenia, the prognosis for recovery is quite favorable.

The patient can live for many years, remaining clean, well-mannered, not forgetting about hygiene and his professional achievements.

The distinct stages of transient dementia are difficult to determine.

In rare cases, an unfavorable outcome occurs gradually, with the presence of acute elements of delirium, paranoia, and hallucinations.

However, with successful treatment, the individual is able to maintain working capacity and the prognosis for life is quite favorable.

What should relatives do?

At moments when the patient manifests acute stage illness, in the form of delusions or hallucinations, should be caused ambulance. The person is hospitalized for 1-2 months. There he will receive intensive treatment and nutrition. The patient will be able to take care of himself independently.

When a family member returns home, he behaves absolutely normally, works, prepares food, maintains hygiene, and is polite to his family. You should not blame him for non-standard solutions to some issues. It is still unknown which people are sicker in this life and whose decisions are more correct.

The person is not dangerous either to himself or to others. Do not create stressful situations for him so that the condition does not worsen. Show more love and understanding.

Causes of dementia in schizophrenia

There is a debate among doctors about whether dementia in schizophrenia should be considered such at all. Since a person retains memory and general judgments, intelligence, only the manner of thinking changes.

A person suddenly begins to be afraid and hide. Emotions of fear arise from fantastic hallucinations. It can be assumed that the person was afraid of something. The cause of the exacerbation of the condition could be stress, some terrible event that occurred in a person’s life. Anxiety, depression, lack of understanding and love from others can lead to an exacerbation of the disease.

Symptoms of schizophrenic dementia

Symptoms of dementia appear during an exacerbation period, when a person is depressed and afraid. The following behavior changes are possible:

• a person hides in fear;
• orientation in space disappears;
• children's behavior in adults;
• touches the ear instead of the nose, at the request of the doctor;
• speech becomes meaningless, but remains literate;
• excitement gives way to apathy and lethargy.

Gradually, orientation in space and time returns. Anxiety disappears, the patient becomes adequate and communicates normally. The period of exacerbation of psychosis falls out of memory.

Diagnosis of the disease

Schizophrenic dementia is easily confused with various other mental illness. The psychiatrist must conduct tests and talk with relatives.

The general state of health is determined by blood and urine tests, and an ECG.

Treatment

Psychotherapy helps a person get rid of fears and feelings of loneliness and misunderstanding. Sessions of hypnotic, calm, shallow sleep, accompanied by relaxation music, very positively change a person’s thinking. When the patient understands that he is loved, he feels better.

Drugs

Modern psychiatrists prescribe new drugs that are easier to tolerate than in earlier generations.

Patients with schizophrenia are prescribed:

• neuroleptics;
• anti-anxiety tranquilizers;
• sedatives;
• antidepressants.

For hallucinations and delusions they take antipsychotics. In the future, these medications are taken to reduce the risk of exacerbations, as maintenance therapy.

In the absence of attacks of schizophrenia, dementia of this type does not appear.

Traditional methods

You should consult your doctor about the use of tinctures and decoctions.

Motherwort and valerian can be taken as sedatives.

If a person has asthenia or low blood pressure, tinctures of ginseng and Chinese lemongrass help.

Tea with lemon balm and peppermint helps to improve sleep.

As maintenance therapy, herbal soothing infusions reduce the risk of exacerbations of dementia.

Nutrition, diet

A varied and high-calorie diet is necessary to maintain good health and mood.

Freshly squeezed juices in moments of exacerbation are more likely to return a person to a normal state. In normal times, fruits and vegetables should be on the table every day.

Eggs, sour cream, milk and fermented baked milk, poultry, rabbit, and nuts must be included in the diet. Food must contain enough fats, proteins, fiber, vitamins, and carbohydrates to maintain normal human life.

Then the patient will not have thoughts of fear and oppression, abandonment.

Exercises

Leonardo da Vinci said that a razor begins to rust from disuse, and the mind, having stopped exercising, begins to weaken and indulges in idleness.

Therefore, a patient with schizophrenia should solve mathematical problems and study physics lessons with children. Chess, corner games, puzzles and rebuses preserve intelligence well.

Light physical activity is also helpful. Pleasant music and dancing heal spiritual wounds and give gymnastics to the mind. Memorizing complex movements is useful. At this time, the brain begins to work, new neural chains appear.

Prevention

In order not to subject a person’s psyche to unbearable tests, one should protect him from stress and surround him with love and care.

Kind words, sincere conversations, pleasant music soothe, relieve fears and phobias.

Proper nutrition, no alcohol, sports, travel, walks in the forest, all this keeps a person a healthy psyche. In summer it is useful to go to the pool, swim in the sea and river. Outdoor games and theater, ballet and pop music, all this is interesting and useful in order to never get dementia.

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Dementia in schizophrenia

Dementia means a persistent irreversible decline in mental activity. But with different concomitant diseases has dementia specific symptoms. For example, dementia in schizophrenia is characterized by a lack of intelligence, caused largely by emotional and volitional deviations, but without deep organic changes. You can also find names like vesanic, ataxic or apathetic dementia. There is still a lot of uncertainty about the causes of the origin of this disease, as with schizophrenia itself.

Clinical picture

First of all, patients develop apathy, in which there is no interest in anything, the person is passive, and is characterized by a lack of hobbies or attachment. Such a patient either does not answer questions at all, or the answer will be inadequate - usually the first thing that comes to mind. It is easier for him to answer “I don’t know” to the question posed. The patient is unable to use his knowledge and skills to solve even a simple life situation, so planning becomes impossible for him. The patient's behavior can be described as helpless and strange. It is very difficult for such a person to concentrate. But when performing any task, the patient, ignoring serious issues, will pay all attention to minor details.

In schizophrenic dementia, memory for a long time is not changed, the ability for abstract thinking is preserved, but there is no focus. Most often, passivity and indifference make it impossible to achieve any result. It should also be added that patients retain the ability to navigate in time and space for a long time. Not feeling the need for work, these people do not strive to work. Outwardly, they look sloppy due to their unwillingness to wash or dress appropriately.

A characteristic feature of the disease is the occurrence of ataxic thinking - the presence in the patient’s speech of incompatible concepts. The patient’s speech contains unexpected turns of phrase (neologisms, symbolism). IN arithmetic operations There are usually no errors

Gradually, as a result of inaction of the intellect, a loss of knowledge and skills occurs. There is a depletion of emotions and impaired thinking; this condition is called apathetic-abulsic syndrome. As dementia progresses, dementia increases, noticeably more a sharp decline intelligence, apathy and absent-mindedness increase, and in some patients autism develops.

At a later stage, patients are completely indifferent to what is happening, sit or lie motionless, ignoring even their natural needs, they often need to be spoon-fed, and verbal communication with them is impossible. But for a long time, familiar gestures remain.

Schizophrenic dementia is characterized primarily by emotional disturbances, while intellectual disorders, as well as acquired knowledge and skills, are initially practically not affected. However, patients cannot use them. Therefore, psychiatrists often call this pathology a schizophrenic defect, and not dementia.

Forecast

The prognosis for this disease is questionable. If further deterioration of dementia can be stopped, the prognosis may be favorable. Otherwise, there is an increase complete apathy. With proper treatment, the manifestations of the disease can be smoothed out, but it is impossible to get rid of the disease completely. However, today there are individual treatment programs for both patients and their relatives, as well as social and rehabilitation measures.

Dementia and defect in schizophrenia

Dementia is a total change and devastation of personality, severe thinking disorders, apathetic or disorganized behavior in the absence of criticism of one’s condition.

Specificity of schizophrenic dementia.

Loss or sharp decline in spontaneity and initiative;

Profound impairment of intellectual activity (a sharp decrease in the ability to mock, judge, generalize, understand the situation - complete loss of all intellectual baggage, the entire stock of knowledge, destruction of any interests.

All this creates a “ruin syndrome” (described by A.O. Edelshtein in the 30s).

Ruining syndrome is observed in 15% - 22% of cases of schizophrenia. Its formation is difficult to associate with any form of schizophrenia, but more often with catatonic and hebephrenic forms.

Clinic: complete indifference and indifference, a frozen smile, lack of understanding of basic questions, answers like schizophasia, indifference when meeting with relatives, lack of the slightest concern for the family, gluttony, sloppiness (they often do not use a spoon when eating).

The defect, unlike dementia, is a relatively mild form of partial weakening of mental activity. Patients in the stage of stable remission tend to restore, to varying degrees, a critical attitude towards the manifestations of the defect.

A defect is a primary negative symptom, i.e. reflecting persistent deficit personality changes. They must be distinguished from secondary negative ones - associated with the current exacerbation of psychosis, depression, neurolepsy.

It is impossible to determine the depth and type of negative/deficit disorder at the active stage of the process. During an exacerbation or in the stage of incomplete remission, both primary and secondary negative disorders are present in the clinic.

Primary negative disorders (consequences of the disease itself) are extremely difficult to distinguish from side effect medications, hospitalization, loss of social status, lowering the level of expectations from relatives and doctors, getting used to the role of a “chronically ill person,” loss of motivation, hope.

Typology of defect in schizophrenia.

When assessing the nature and severity of the defect and the prognosis of the condition, one should remember two provisions of D.E. Melekhov (1963).

1) signs of increasing severity of the defect or the appearance of new symptoms in its structure indicate the continued activity of the process;

2) even pronounced manifestations of the defect are available for compensation if the process has stopped in its development, enters the stage of stable remission, post-processual (residual) state and takes a long, slow, sluggish course without frequent exacerbations.

1) Asthenic - or nonspecific “pure” defect (Huber), “reduced energy potential” (Conrad K.), “dynamic devastation” (Janzarik W), “primary adynamia” (Weitbrecht) - this is a decrease in energy potential and spontaneous activity, and level of goal-directed thinking and emotional responsiveness (Huber).

“Decreased energy potential” according to Conrad K. (1958) is characterized by a decrease in the strength of mental tension, will, intensity of desires, interests, level of motivation, dynamic activity in achieving a goal;

“Dynamic devastation” according to Janzarik W (1954, 1974) - includes a decrease in emotional tension, concentration, intentional impulsiveness, readiness for action, which is manifested by emotional coldness, dishonesty, lack of interests, and lack of initiative.

The structure of an asthenic defect is intellectual and emotional impoverishment, mildly expressed thinking disorders, and a narrowing of the range of interests. The behavior of patients is outwardly ordered. Household and simple professional skills, selective attachment to one of the relatives or medical staff are preserved, and the feeling of one’s own change is preserved.

2) Fershroben (acquired deficit or expansive schizoidia according to Smulevich A.B., 1988).

Structure – autism in the form of pretentiousness, absurdity of actions with a separation from reality and life experience. Reduced sensitivity and vulnerability, disappearance of the tendency to internal conflict, fading of related feelings. The sense of tact, humor, and distance disappears. In general, there is a decrease in criticality and emotional hardening. Former creative abilities are lost (decreased). Cognitive activity comes down to the use of insignificant, latent properties and relationships of objects, considering them in unusual aspects and connections, the use of rare words, neologisms, and a tendency to pretentious expressions. “Pathological autistic activity” comes down to pretentious actions, divorced from reality and past life experience. There are no clear plans or intentions for the future. The lack of criticism is manifested by a disorder in assessing one’s “I”, in the form of awareness of one’s own individuality through comparison with others. In everyday life, oddities - cluttered home, unkemptness, neglect of hygiene, contrast with the pretentiousness of the hairstyle and toilet details. Facial expressions are unnatural, artificial, motor skills are dysplastic, movements are angular. Emotional hardening is manifested by a reduction in sensitivity and vulnerability, the disappearance of the tendency to internal conflict, and the extinction of related feelings. The sense of distance and tact is grossly violated. Often - euphoria, out of place jokes, complacency, empty pathos, regressive syntony.

3) Psychopathic-like (pseudopsychopathy) – typologically comparable to constitutional personality anomalies (psychopathy).

This type of defect is predisposed by: a) the association of active (manifesting) periods of the disease with age-related crises, b) a poorly progressive course, c) the presence in the initial period of schizophrenia of an affinity for disorders of the psychopathic circle.

Pseudopsychopathies in the clinic of paroxysmal-progressive schizophrenia are described in the idea of ​​2 options for post-processual personality development (Smulevich A.B., 1999).

1. “idealists alien to the world” according to E. Kretschmer (1930) - with a new approach to reality, hermits, unsociable eccentrics, indifferent to the fate of relatives, with a worldview subordinate to the ideas of spiritual self-improvement, detached from vain affairs, with autistic hobbies. This also includes personality changes of the “second life” type (Vie J., 1939) with a radical break with the entire system of premorbid social, professional and family ties. Change of occupation, formation of a new family.

2. residual states according to the type of dependent individuals (psychasthenic remissions according to V.M. Morozov, R.A. Nadzharov). Doubts about any reason, loss of initiative, the need for constant encouragement, passive submission, the position of “adult children” in the family. In production conditions, they get lost with minor deviations from their usual activities, and in non-standard situations they take a passive position with avoidant behavior and refusal reactions.

4) Syndrome of monotonous activity and rigidity of affect (D.E. Melekhov, 1963).

Patients are distinguished good performance, passion, tirelessness, invention, innovation, professional erudition in stereotyping the working day and planning. The range of interests is preserved, but with the possibility of one hobby. Along with this, there is a lack of emotional resonance, a decrease in sympathy and empathy, dryness and restraint of emotional manifestations, external sociability and breadth of contacts in the absence of truly close people, inflexibility and avoidance of solving family problems. There is resistance to frustration, lack of reactive lability, inflated self-esteem, not always adequate optimism, lack of critical attitude and rationalization in explaining the causes of the attack.

5) Pseudoorganic - formed during the development of schizophrenia on organically altered soil.

It is characterized by a drop in mental activity and productivity, intellectual decline, rigidity of mental functions, leveling of personal characteristics, narrowing of contacts and range of interests (simple deficiency type defect (Ey H., 1985), autochthonous asthenia (Glatzel J., 1978)). It is formed more often against the background of a family predisposition to schizoid psychopathy.

5) Syndrome of infantilism and juvenileism - most often formed during atypical attacks suffered in adolescence and adolescence with heboid, pseudoneurotic, atypical depressive, dysmorphophobic disorders or overvalued formations such as metaphysical intoxication. “Juvenilism” is reflected in the manner of dressing, behaving in a group, in the choice of hobbies, friends, profession and worldview.

Neurocognitive deficits in schizophrenia.

IN last years– in psychiatry, the paradigm of the biological basis of mental disorders has received intensive development, within its framework - the concept of neurocognitive deficit in schizophrenia.

The neurobiological model of schizophrenia suggests a violation of the formation of the central nervous system, in the form of a decrease in the volume of gray matter, a decrease in the level of metabolism, membrane synthesis and regional blood flow of the prefrontal cortex, and a decrease in delta sleep on the EEG. But there is no evidence of damage to any specific area of ​​the brain. The disturbances occur at the synaptic level, although there is evidence in the literature of structural disturbances.

Neurocognitive deficit is a form of information processing disorder, deficiency of cognitive function: memory, attention, learning, executive function. It is observed in 97% of patients with schizophrenia and only 7% in the healthy population. Cognitive decline observed in relatives of patients with schizophrenia. The main intellectual decline occurs in the first 2 years of the disease.

Neurocognitive deficits are considered to be the "third core group of symptoms" in schizophrenia, along with negative and productive disorders.

Intellectual functioning in patients with schizophrenia is relatively unaffected (IQ is only 10% lower than in healthy people). But at the same time, a “deficit” of memory, attention, speed of information processing, and executive functions is revealed. This affects the social, professional viability and quality of life of patients with schizophrenia.

Memory disorders – relate to verbal and auditory modality, working memory deficit (working memory - the ability to record information for use in subsequent activities). A working memory deficit is manifested in a violation of retaining information for a short period during which it is processed and coordinated with other long-term mental operations, which ultimately leads to the development of a response. The ability to concentrate is an indicator of ability to solve problems and acquire skills.

Attention impairment - auditory and visual modality, difficulty maintaining attention for a long time, sensitivity to distractions.

Insufficiency of executive function in schizophrenia (drawing up and implementing plans, solving new problems that require the use of new knowledge. The state of executive function determines the ability to live in society) - weak ability to plan, regulate behavior and set goals.

“Cognitive profile” of patients with schizophrenia (based on the results of averaged neurocognitive tests).

A normal or near normal reading test result;

The lower limit of tests assessing simple sensory, speech and motor functions;

a decrease of 10 points in IQ according to the Wechsler test;

Reduction by 1.5 - 3 standard deviations in test scores for memory assessment and more complex motor, spatial, and linguistic tasks;

Extremely low results in tests for attention (especially stability of attention) and tests testing problem-solving behavior.

AFFECTIVE MOOD DISORDERS.

Affective disorders are a group of mental disorders with various options currents, main clinical manifestation which is a pathological decrease or increase in mood, accompanied by a violation of various areas of mental activity (motivation of activity, drives, voluntary control of behavior, cognitive functions) and somatic changes (vegetative, endocrine regulation, trophism, etc.)..

Ancient period -Hippocrates “melancholy”, “black bile”

1686 Theophile Bonet: “manico-melancolicus”

1854 J. Falret and Baillarger: “circular madness”

1904 Emil Kraepelin“manic-depressive psychosis”.

Symptomatology – polar, phasic affective fluctuations

Emotions - melancholy, depression, sadness, hopelessness, worthlessness, a feeling of twina, the meaninglessness of existence; anxiety, fears, worry; pessimism; loss of interest in family, friends, work, sex; inability to have fun, have fun - anhedonia

Thinking - slowness of thinking, difficulty concentrating, making decisions; thoughts of failure, low self-esteem, inability to switch from negative thoughts; loss of a sense of reality, possible appearance of hallucinations and delusional ideas of depressive content; suicidal thoughts (about 15% of untreated patients with affective illnesses commit suicide).

Physical condition - changes in appetite and weight (70% lose weight, others gain); sometimes an excessive desire for sweets develops; sleep disorders: although insomnia is a common complaint, about 10% feel an increased need for sleep and they do not feel rested even after hours of sleep; loss of energy, weakness, drowsiness; various pain sensations (headaches, muscle pain; bitter taste in the mouth, blurred vision, digestive disorders, constipation; agitation and restlessness.

Behavior - slow speech, movements, general “lethargy”; excessive tearfulness or, conversely, the absence of tears even with the desire to cry; alcohol and/or drug abuse.

Typology of depressive syndromes: Melancholic depression; Depression with anxiety; Anesthetic depression; Adynamic depression; Depression with apathy; Dysphoric depression; Smiling (or ironic) depression; Tearful depression; Masked depression (“depression without depression”, somatization of depression) Somatization is a manifestation of a mental disorder in the form of physical suffering.

The main symptom of mania is increased elation. As a rule, this mood grows in a certain dynamic sequence, which includes a sequential change of the following phases:

Elevation of mood within normal limits: happiness, joy, fun (hyperthymia);

Moderate rise: increased self-esteem, increased ability to work, activity, decreased need for sleep (hypomania);

Mania itself: manic symptoms grow and begin to disrupt the patient’s normal social activity;

- “delusional” or psychotic mania: excessive overactivity, irritability, hostility, possible aggression, delusions of grandeur and hallucinations

Emotions - elevated mood, feeling of elation, euphoria, ecstasy.

But the following are possible: irritability, anger, excessive reaction to ordinary things, lability, rapid mood swings: a feeling of happiness and a minute later anger for no apparent reason, hostility.

Thinking - increased self-esteem, ideas of greatness, personal power; incorrect interpretation of events, introducing your own meaning into comments of ordinary content; distractibility, lack of concentration; jumping ideas, flight of thoughts, jumping from one topic to another; lack of criticism of one’s condition; loss of sense of reality, possible appearance of hallucinations and delusions.

Physical state - increased energy, shorter sleep - sometimes only 2 hours of sleep is enough, heightened perception of all senses - especially colors and light.

Behavior – involvement in adventures and grandiose plans. involuntary uncontrollable desire to communicate: can call friends on the phone many times at any time of the night to discuss their plans, excessive spending of money, often just giving money away, meaningless numerous purchases, jumping from one activity to another, laughing, joking, singing, dancing. Possible: malice and demandingness. Talkativeness, speech is fast and loud. The emergence of a new interest in collecting something, increased sexual activity.

In the ICD-10 classification - combined under heading F3 “AFFECTIVE MOOD DISORDERS”

According to modern concepts, painful episodes of mood disorders are a combination of symptoms (manic or depressive) that make up a dominant affective state.

Etiology: predominantly hereditary, autochthonous course.

The first episodes of the disease are often preceded by mental trauma (mental and physical stress), physiological changes (pregnancy, childbirth), exogenous factors (TBI, intoxication, somatic diseases) and subsequently their significance weakens.

TYPES OF AFFECTIVE DISORDERS (according to ICD-10, DSM-1V classification).

Recurrent depression (Major depression)

Other depressive disorder

Other bipolar disorders

3.Other affective disorders:

Recurrent depression (DSM-1V major depression)

Epidemiology: prevalence: men 2-4%, women 5-9% (men: women = 1:2), average age started:

Genetic: 65-75% - monozygotic twins, 14-19% dizygotic twins

Biochemical: neurotransmitter dysfunction at the synaptic level (decreased activity of serotonin, norepinephrine, dopamine)

Psychodynamic (low self-esteem matters)

Cognitive (negative thinking matters).

Risk factors - gender: female, age: onset in the age range of years; presence in the family history (heredity) of depression, alcohol abuse, personality disorders.

History (especially early) - loss of one of the parents before the age of 11; negative conditions of upbringing (violence, lack of attention).

Personality type: suspicious, dependent, obsessive.

Psychogenics - recent stress/psychotraumatic situations (illness, trial, financial difficulties), postpartum trauma, lack of close, warm relationships (social isolation).

DYSTYMIA is a variant of depressive disorders with moderately severe symptoms and chronic course(more than 2 years).

Features of low mood with dysthymia:

prevails increased sensitivity to the environment, irritability, touchiness, angry reactions. Inconsistency of actions and thoughts. Emotional and sensory hyperesthesia. Unstable (usually overestimated in hidden form) self-esteem. Lethargy, relaxation. Getting stuck on grievances and failures, imagining the ill will of others. Preservation of motives when it is difficult to realize them. More often increased appetite

If syndromic complete depression develops against the background of dysthymia, “double depression” is diagnosed.

BIPOLAR DISORDER (BD).

Bipolar disorder type 1 is characterized by the presence of 1 or more manic or mixed episodes and at least 1 episode of syndromic-complete depression.

Bipolar disorder type 11 - 1 or more syndromic-complete depressive episodes and at least 1 hypomanic episode.

1) Genetic predisposition - concordance of monozygotic twins is 65-85%, dizygotic twins - 20%, 60-65% of patients with bipolar disorder have a family history of mood disorders

2) Environmental factors contributing to the manifestation of BD - stress, antidepressant therapy, sleep-wake rhythm disturbances, abuse of PA substances.

Prevalence - Lifetime prevalence: 1.3% (3.3 million people in U.S.) Age of onset: teenage years and around 20 years

The flow is periodic, in the form of double phases, and continuous.

80-90% of patients with bipolar disorder have multiple relapses. The average number of episodes of the disease during life is 9

The duration of remissions (periods without symptoms of the disease) decreases with age and the number of previous episodes.

Diagnostics. Patients visit an average of 3.3 doctors before a correct diagnosis is made

The average time to correct diagnosis is 8 years after the first visit to the doctor (60% of patients do not receive treatment within 6 months of the initial episode; 35% of patients do not even seek help for 10 years after the first symptoms of the disease; 34% patients are initially given a diagnosis other than bipolar disorder).

Suicide rate. 11-19% of patients with bipolar disorder commit suicide. At least 25% attempt suicide. 25-50% of patients have suicidal thoughts in a state of mixed mania

Differentiation between BD and unipolar depression is important.

Family history - Individuals with BD are more likely to have a family history of mood disorders, as well as substance abuse.

PD has a more pronounced hereditary predisposition.

Age of onset – PD often manifests in adolescence, and UD - after 25 years.

Course - PD occurs in more defined phases (with abrupt start and cliff) and has a more pronounced seasonality in its manifestations.

Response to therapy – in PD, antidepressants are less effective and often promote progression to mania.

CYCLOTHYMIA is a mild variant of bipolar affective disorder. Often seasonal. There are winter-spring and autumn depressions.