Schizophrenia article. C. G. Jung Schizophrenia

Schizophrenia is a mental illness with a long-term chronic course, leading to typical personality changes (schizophrenic defect). This disease is characterized by a kind of discordance (splitting, disunity) of thinking, emotions and other mental functions. The term schizophrenia literally means “splitting of the soul” (“schizo” from Greek - splitting, “phren” - soul, mind). Schizophrenic personality changes are expressed in increasing isolation, isolation from others, emotional impoverishment, decreased activity and purposeful activity, loss of unity mental processes and peculiar thinking disorders. These painful changes in the psyche are also called deficiency or minus symptoms, because they constitute a defect in the patient's personality. The development of such a personality deficit (defect) is closely related to various mental disorders that are not absolutely specific to this disease, but reflect its clinical picture.

These so-called secondary or productive disorders (pathological brain production) can be represented by various mental disorders: hallucinations, delusions, decreased or increased mood, state of lethargy or excitement, confusion. The causes of schizophrenia and the mechanisms of its development are not well understood. The leading role belongs to hereditary factors. Gender and age are of great importance in the development of the disease. In men, the disease begins earlier and often proceeds continuously with a less favorable outcome. For women, the paroxysmal course of the disease is more typical, which is to a certain extent associated with the cyclical nature of neuro-endocrine processes ( menstrual function, pregnancy, childbirth), and the prognosis is generally more favorable. Malignant forms of the disease usually begin in childhood and adolescence.

Symptoms and course:

The clinical picture of schizophrenia is represented by a wide range of psychopathological manifestations. The most typical are disorders of the intellect and emotions. With thinking disorders, patients complain of the inability to concentrate thoughts, difficulties in assimilation of material, uncontrollable flow of thoughts, blockage or stopping of thoughts, parallel thoughts. At the same time, they are characterized by the ability to capture special meaning in words, sentences, works of art. They can create new words (neologisms), use certain symbolism and abstraction that only they understand when expressing their thoughts and in their creativity. It can be difficult to grasp the meaning of their speech due to the florid, logically inconsistent presentation of thoughts. In patients with a long-term unfavorable course of the disease, there may be discontinuity of speech (loss of semantic connection between individual parts of a sentence) or incoherence (a set of words).

In addition, patients may experience obsessive thoughts (thoughts that arise against the will of a person and are alien to his personality, which he recognizes as painful, but which he cannot get rid of). This is an obsessive reproduction in memory of dates, names, terms, obsessive counting, obsessive fears, representations, reasoning. The patient may spend a long time thinking about the meaning of life and death, why the Earth is round and the Universe is infinite, etc. With their obsessive thoughts the patient fights with the help of obsessive actions - rituals that bring him relief for a certain time. So, for example, with fear of infection infectious disease or simply if the patient is afraid of dirt, he must wash his hands a strictly certain number of times. If he does this, he calms down a little, if not, then fear and anxiety intensify.

Patients may have delusional ideas, erroneous judgments and conclusions that arise on a painful basis, completely take over the patient’s consciousness and cannot be corrected (the patient cannot be dissuaded). Delusional ideas can arise primarily, through a painful interpretation of real facts and events, and secondarily, i.e. based on impaired perception (hallucinations). Delusional ideas can have different contents: persecution, poisoning, witchcraft, influence, jealousy. Delirium is very typical for patients with schizophrenia. physical impact when it seems to them that they are being affected by hypnosis, electromagnetic or x-ray radiation with the help of special installations, transmitters, both from Earth and from space. At the same time, patients hear in their heads the “voices” of those people who influence them, control their thoughts, emotions, and movements. They can also see “films” or “special pictures” that are shown to them by imaginary people (whose voices they hear), smell various smells, often unpleasant, experience painful sensations in the body and head in the form of burning, transfusion, drilling, shooting. Deceptions of perception (auditory, visual, olfactory, gustatory, tactile) or the perception of imaginary objects and stimuli are called hallucinations.

Emotional disturbances begin with the loss of a sense of affection and compassion for parents and loved ones, the disappearance of interest in study, work, isolation, and isolation. Sometimes patients become rude, angry towards loved ones, and treat their parents as strangers, calling them by name and patronymic. The sense of responsibility and duty disappears, which is reflected in behavior. Patients stop fulfilling their duties, take care of their appearance (they don’t wash, don’t change clothes, don’t comb their hair), wander around, and do ridiculous things. Along with these deficiency symptoms, patients during an exacerbation may have a depressed (depressive) or elevated (manic) mood. Patients experience a pronounced decrease in volitional activity (purposeful activity), leading to complete indifference (apathy) and lethargy. Moreover, the severity of volitional disorders, as well as emotional ones, correlates with the severity of the personality defect. The so-called apato-abulic syndrome forms the basis of the schizophrenic defect.

Characteristic of patients with schizophrenia are peculiar motor-volitional disorders (catatonic). The patient may be in a state of catatonic stupor (complete inhibition). Such patients can lie for a long time (sometimes weeks, months) in the uterine position with their knees bent and their legs pressed to their stomach, without reacting to others, without answering questions, without following any instructions. They refuse to eat, and the staff is forced to force-feed them (through a tube) to avoid starvation. Some patients experience the air cushion symptom, in which they lie on their backs with their heads elevated above the pillow. Long-term preservation of a certain position by patients is possible due to their existing waxy flexibility, which appears as a result of a peculiar redistribution of muscle tone. Patients can maintain an artificially given position for quite a long time. Refusal to follow instructions (negativism) can be passive (simply does not respond to words) and active (does the opposite). Patients may experience unfocused, chaotic arousal (catatonic) with stereotypical actions, increased aggressiveness, and unpredictability of actions. Such patients may have echo symptoms when they repeat words, movements, or copy facial expressions after someone around them. Patients in this condition can be dangerous to themselves (self-harm) and others (aggressive actions) and should be immediately hospitalized. The catatonic state may be accompanied by dreamlike hallucinations of fantastic content (waking dreams or oneiric stupefaction. One of the most unfavorable, malignant symptoms is the state of hebephrenia - agitation with foolishness, mannerism, pretentiousness of movements and speech. Patients grimace, tease, distort words, make various jokes. Their behavior is not controllable and predictable. This state often gives way to catatonic excitement.

As can be seen from the above, the clinical manifestations of schizophrenia are varied, but have their own characteristics. The outcomes of the disease are also different, from barely noticeable personality changes that have little effect on social adaptation, to a deep defect that makes it impossible for the patient to stay outside the hospital. These differences are associated with the course of the disease, the degree of its progression, and the age of onset of the disease.

There are three types of schizophrenia:

• continuous;
• periodic (recurrent schizophrenia);
• fur coat-like (from the word “fur coat” - shift, attack).

Recognition:

It is difficult only at the beginning of the disease. If the first attack in periodic schizophrenia is represented by purely emotional disorders, it is difficult to differentiate it from the phase of manic-depressive psychosis. Certain difficulties arise when diagnosing schizophrenia in childhood, since the first pronounced attack is usually noted only in adolescence. In children, symptoms of the disease include movement disorders, fears, and obsessions. Hallucinations are predominantly visual, instead of delusional ideas, delusional fantasies. Depression is expressed mainly in lethargy, moodiness, and discontent. Elevation of mood is manifested by motor disinhibition, cheerfulness, and fussiness. In some cases, psychological testing is used for diagnosis to determine the characteristics of the character, level and type of thinking.

Schizophrenia is still played out in popular culture, as an incurable disease that destroys a person’s personality and contributes to his moral and physical degradation.

Movies, books and computer games about patients of psychiatric clinics with schizophrenia, they often make the basis of their plots the all-consuming “madness” of the main characters, who have long lost their “I” in the unequal struggle with the disease.

But in reality, everything is not as scary and hopeless as entertainment industry workers imagine it. Schizophrenia is not a death sentence, and the myths that still circulate about this disorder are often very far from reality.

Update will tell you some interesting things about schizophrenia that will help you look at the disease differently.

Schizophrenia is not a personality disorder

The idea that patients with schizophrenia have a split personality is perhaps one of the most common misconceptions about this disease.

One survey found that 64% of Americans think of schizophrenia in exactly this way.

However, schizophrenia is not actually associated with personality disorders. This condition is characterized by the emergence of conflicting ideas in the patient's reasoning, his indecisiveness and his emotional ambivalence, but the person with schizophrenia still feels like himself.

The presence of mutually exclusive thoughts does not indicate a split personality.

Schizophrenia is not a cause of aggression and violence

People suffering from schizophrenia experience symptoms characteristic of an anxiety disorder and are generally passive in nature.

The myth that people with schizophrenia are aggressive and cruel has grown out of misrepresentations of the disease in movies and television.

In fact, only 5-10% of people with schizophrenia are capable of engaging in criminal activity, despite the fact that patients with the disorder can sometimes behave unpredictably.

When people with schizophrenia do commit violent acts, it is often due to completely different problems, such as alcohol or drug abuse or deep emotional trauma from childhood.

The percentage of patients with schizophrenia remains stable

Research and statistics show that the percentage of people with schizophrenia remains at the same level for many decades, all over the world.

“Around the world, approximately 1% of the population suffers from schizophrenia. It has long been determined that this figure does not change and does not depend on culture, economy, or geographic location,” the head physician of the Kiev Clinical Psychoneurological Center confirms this thesis in an interview with Radio Liberty Hospital No. 1 Vyacheslav Mishiev.

At the same time, the number of patients among men and women is approximately the same. The only difference is that schizophrenia comes to women a little later than to men - after 30 years.

Scientists suggest that this is due to the fact that the hormones estrogen and progesterone have protective effect against schizophrenia.

Schizophrenia is successfully treated

Despite the fact that there is not yet a single cure for schizophrenia, there are quite effective therapeutic methods and medications that help patients cope with the symptoms of the disease and live a full life.

A properly selected course of treatment helps about 25% of patients cope with schizophrenia completely or almost completely.

Another 50% of people with this diagnosis note that therapy helped them significantly alleviate the symptoms of the disease.

Just because one of your parents had schizophrenia does not mean you will have it too.

Genetics plays a role, but if there is a history of schizophrenia in your family, this does not mean that the same fate awaits you.

The risk of developing the disease if one of the parents has it is approximately 10%. But it increases if there was more than one such case in your family.

Schizophrenia does not affect intellectual abilities

Some studies have found that people with schizophrenia have some difficulties with attention, memory and learning. But this does not mean that they have low intelligence.

Many incredibly smart and creative people have suffered from schizophrenia, which had no effect on their extraordinary intellectual abilities.

For example, laureate Nobel Prize in mathematics, John Nash suffered from schizophrenia, but this did not stop him from demonstrating his brilliant skills.

Schizophrenia is associated with high dopamine levels

Scientists suggest that the cause of schizophrenia may lie in a chemical imbalance in the brain. Namely, high levels of dopamine.

We need this substance to keep our mood stable. If dopamine levels are too low, we risk developing depression or anxiety disorder. If its level is too high, the likelihood of mania and hallucinations increases.

For the bulk of ordinary people who are alien to knowledge in the field of psychiatry, a disease such as schizophrenia is associated with a lifelong stigma, and “schizophrenic” is a symbol of the end of life and the meaninglessness of existence for society. But is this really so? Unfortunately, with such an attitude from the public, this will be exactly the case. After all, everything unknown is alarming and causes hostility. And the poor fellow suffering from schizophrenia, according to the generally accepted opinion, becomes an outcast (it is worth noting, alas, only by our compatriots; in any other civilized society this is completely different), because those around him experience fear and their understanding is far from what kind of “fruit” is wrong with them is nearby. And what’s even more disgusting is that they can even mock and mock the patient. But there is no need to consider a sick person an insensitive monster, because the sensitivity of precisely such patients is extremely heightened, and they perceive the attitude of others towards themselves especially acutely.

I would like to hope that this article will be able to arouse your interest, make you show understanding, and therefore sympathy for those suffering from schizophrenia. I would also like to point out that a considerable number of very creative and publicly famous personalities, scientists, and people you personally know well are found among such patients.

So let’s strive together to understand the definition of “schizophrenia”, let’s try to understand its syndromes and symptoms, features and likely outcomes.

So, translated from Greek, Schizis means splitting, and phrenus means diaphragm (it was once believed that the human soul is located there). This is the most common disease among others mental disorders. Today, about 45 million people suffer from it, which is about one hundredth of the total population of the planet. Schizophrenia does not select a person's race, nationality or culture. However, there is still no clear definition of this anomaly, as well as possible reasons appearance.

In general, the term “schizophrenia” was introduced into psychiatry in 1911 by Erwin Bleuler, and until that moment the expression “premature dementia” was used.

Russian psychiatry defines schizophrenia as a chronic endogenous disease, expressed by various positive and negative symptoms, with particularly pronounced increasing personality changes.

Having analyzed the definition of schizophrenia in more detail, we can conclude that the disease has a long period of progression and goes through several stages and patterns in its development with successive syndromes and symptoms. Negative symptoms mean the “loss” of some pre-existing signs characteristic of this person from the total mental activity. And by positive symptoms we mean the appearance of new signs, for example, hallucinations and delusions.

Characteristic signs of schizophrenia

Constantly occurring forms of the disease - cases with a smooth gradual progression of the disease with to varying degrees manifestations of both negative and positive symptoms. With this form of development of the disease process, symptoms appear from the very beginning of the disease and throughout life. And psychosis in its manifestation is based on two main components - hallucinations and delusional ideas.

Such forms of ongoing disease exist in parallel with personality changes. You can notice some oddities in a person - he becomes withdrawn, does absurd things that defy the logic of those around him. One can also observe a change in the range of his interests with the addition of new ones, previously uncharacteristic of this person hobbies. Sometimes these may be religious or philosophical teachings of dubious content, or adherence to the customs and traditions of classical religions with ardent fanaticism.

In such patients, performance and adaptation to society are noticeably reduced or completely lost. And in especially severe cases, passivity and indifference may appear, up to a complete loss of interest.

The paroxysmal nature of the course of the disease is characterized by the manifestation of clear individual attacks in combination with mood swings, which makes this form similar to manic-depressive psychosis, especially since mood disorders play an important role in the overall picture of attacks.

With such a course of the disease, psychosis appears as separate episodes, in between which there are moments of a relatively favorable psycho-emotional state, accompanied by a sufficient degree of labor and social adaptation. Such “enlightenments”, if they last for a long time, can even lead to a complete restoration of ability to work.

The position between the described forms of course is assigned to episodes of the paroxysmal-progressive form of the disease, when the constant course of the disease is supplemented by active attacks, the clinical symptoms of which are similar to attacks of recurrent schizophrenia.

As Erwin Bleuler believed, when characterizing schizophrenia, the main attention should be paid not to the outcome, but to the “core disorder”. Among other things, it was he who identified the four “A” - a complex of signs characteristic of schizophrenia:

1. A symptom of autism (translated from Greek “autos” - own) is renunciation of the surrounding world, full immersion with your own inner world;
2. Affective inadequacy is a phenomenon when the patient’s reaction to a standard circumstance is inadequate, for example, the news of the death of a close relative causes laughter and joy;
3. Associative defect (today it is “alogy”) - lack of logical holistic thinking;
4. Ambivalence is the simultaneous presence in the patient’s psyche of affects of different directions, for example, love/hate.

Symptoms of schizophrenia

Having arranged the symptoms according to the strength of their increase, French psychiatry proposed scales schizophrenic symptoms, and Kurt Schneider, a German psychotherapist, characterized the symptoms of the first two ranks. Symptoms of the first rank are still used in practice to make a diagnosis, becoming distinctive feature namely schizophrenia among the variety of possible mental disorders:

3. Commentary hallucinations.

4. Somatic passivity - the patient’s feeling that his movements are controlled by someone other than himself.

5. “Withdrawal” and “investment” of thoughts in the head, interruption of the thought process.

6. Broadcasting thoughts - as if thoughts are broadcast in the patient’s head through a radio receiver.

7. Feeling of foreignness of thoughts - the patient is sure that someone put thoughts into his head. This also affects feelings. The patient, describing hunger, is sure that it is not he who is experiencing it, but that someone is making him feel it.

8. Delusion of perception - the patient explains what is happening in only one symbolic perspective known to him.

Schizophrenia erases the boundaries of “I” and “not me.” The patient mistakes internal thinking processes for external events, and vice versa. Six of the eight described signs indicate that the boundaries of consciousness are “loose.”

Different psychotherapists have different views on schizophrenia as a phenomenon:

1. This is Kraepelin's disease.
2. This is the Bangöfer reaction. The causes of the disease are varied, however, the brain's response is a limited set of reactions.
3. This is a kind of adaptation disorder.
4. This is a specific personality structure. This view is based on psychoanalysis.

History of the origin of schizophrenia (etiopathogenesis)

Four stand out integrated approach in theory:

1. Genetic factors.

Throughout the planet, there are regularly 1% of those suffering from schizophrenia. Moreover, if one of the parents is sick, then the probability of the child also getting sick is about 11.8%, and if both parents are sick, the probability increases to 25-40% or more.

The probability of simultaneous manifestation of the disease in identical twins is 85%.

2. Theories based on the biochemical processes of the body.

Associated with metabolic disorders of such substances as glutamate, dopamine, acetylcholine, serotonin.

3. Stress theory.

4. Psychosocial hypothesis.

Brief overview of individual theories:

• stress affecting a depressed person. Most involve exposure to stress associated with the demands of the adult role.
• the role of parents who can prepare the ground for development severe forms schizophrenia.
• virus theory.
• a theory that compares the course of schizophrenia with encephalitis, a very slowly developing process of dementia. People with schizophrenia have smaller brain volumes.

In schizophrenics, the ability to perceive information changes, the selectivity of psycho-emotional processes and pathopsychological orientation are disrupted.

Both men and women suffer from schizophrenia to the same extent, but urban residents and the poor are more likely to suffer from schizophrenia, which is associated with a large number suffered stress. Men have an earlier manifestation of the disease and its more complex course than women.

Every year, treatment for schizophrenia costs 5% of the American budget. The disease shortens the life of its “clients” by 10 years. The first place among the causes of death of patients is occupied by cardiovascular pathologies, and the second place is suicide.

Schizophrenics are very resistant to physical activity and biological stress - they can tolerate up to 80 doses of insulin, are rarely susceptible to acute respiratory viral infections and other viral infections, and are resistant to hypothermia. It is a reliable fact that all patients were born at the winter-spring border (in March-April), either due to the vulnerability of biorhythmic processes, or because the mother’s body is susceptible to infections.

Classifications of forms of schizophrenia

Schizophrenia is classified according to the type of disease:

1. Continuously progressive

2. Paroxysmal

a) paroxysmal-progressive (fur-like)

b) periodic (recurrent).

By stages of development:

1. Initial stage.

This is the stage of development from the first detected signs of illness (asthenia) to the manifestation of signs of psychosis - delusions, hallucinations, depersonalization, hypomania and subdepression.

2. Manifestation of the disease – a combination of negative (deficient) and positive (productive) symptoms.

3. Final stage.

When the predominant majority of deficiency symptoms are clearly identified, and the disease freezes.

Based on the speed of development of the disease (degree of progression), the following forms of schizophrenia are distinguished:

1. Rapidly progressive (malignant);

2. Moderately progressive (paranoid form);

3. Low-progressive (sluggish).

The exception is the recurrent form of schizophrenia.

Distinctive characteristics of individual types:

Schizophrenia malignant

Typically, the first symptoms can appear between 2 and 16 years of age. It has a very short initial period - up to a year, and the manifest period can last up to four years.

Characteristics:

a) in the state preceding the disorder (in premorbid), the schizoid personality is an overly withdrawn, uncommunicative individual who seeks to hide from the outside world;

b) immediately leadership positions are occupied by productive symptoms that reach high positions;

c) the third year is accompanied by the formation of apathetic-abulic syndrome - “vegetable life”, but the condition is still in the reversibility phase during a period of possible severe stress, for example, during a fire;

d) treatment is usually based on the symptoms of the disease that appear.

Moderately progressive schizophrenia

The initial stage lasts up to five years. At the same time, new unusual hobbies, strange hobbies and manifestations of religiosity are often observed. This form affects people whose age ranges from twenty years to forty-five.

The manifest stage is accompanied by a delusional or hallucinatory form and can last up to twenty years.

At the final stage, shrapnel delirium with preserved speech can be observed.

The treatment is effective, so drug remissions are possible (but only temporary improvements).

Continuously progressive form of schizophrenia is characterized by a predominance of symptoms of hallucinatory delusions over affective symptoms. A patient with this form of schizophrenia is hospitalized two or three times a year.

The paroxysmal form of schizophrenia, on the contrary, is distinguished by the predominance of symptoms of a disorder of the emotional-volitional sphere. Remissions in this form are spontaneous and deep, and hospitalization is carried out only once every three years.

Schizophrenia is sluggish, neurosis-like

The average age of onset of the disease is from 16 to 25 years. The initial and manifest stages do not have a clear distinction.

Neurosis-like pathologies predominate. The manifestation of schizophrenic psychopathy is characteristic, but the patient retains his ability to work, the ability to maintain social and family relationships, but visually you can see that the person is marked by pathology.

Negative and positive symptoms in schizophrenia

By tradition, let's start looking at the negative ones first.

1.associative defect identified by Engin Bleuler

interpsychic ataxia, identified by Stransky

All this together means a loss of integrity and coherence of psycho-emotional processes in thinking, emotional environment and acts of expression of will.

There is a lack of interconnection between processes, and the processes themselves are characterized by the chaos occurring within them. Schisis is the unfiltered result of thinking. This phenomenon is also observed in absolutely healthy people, but it is controlled by the subconscious. And in patients it is observed mainly at the initial stage of the disease, and disappears with the onset of delirium and hallucinations.

2. Autism.

A schizophrenic is in constant feelings of anxiety and fear when in contact with his environment, and passionately desires to protect himself from all contacts. In short, autism is an escape from interaction.

3. Reasoning.

This is a phenomenon where the patient talks but does nothing to achieve a result.

4. Apathy.

This is a gradually increasing loss of the ability to give an emotional response. The situations to which emotion is given are becoming fewer and fewer.

It begins with rationalization instead of emotion. Hobbies and interests are the first to disappear. The behavior of teenagers is reminiscent of little old people, they seem to succinctly state the essence and reason, but behind such “judgment” hides the obvious poverty of emotional reactions. For example, a teenager responds to a request to brush his teeth with a question. By this he neither agrees nor expresses his refusal, but simply rationalizes. However, in a further conversation, if he is given an argument as to why he should brush his teeth, he will find a counterargument, and the dialogue may drag on for a long time, because by and large, the teenager did not intend to enter into a discussion, but the syndrome of reasoning manifests itself.

5. Abulia.

A term meaning the absence of the patient's will. At first, such behavior seems simply laziness. It begins to manifest itself at first at work, at home, and later in self-care. Such patients tend to lie down more than move.

More often, patients do not experience abulia, but hypobulia against a background of apathy, or rather impoverishment.

The emotional background of schizophrenics remains in a single isolated zone - parabulia - this is what this phenomenon is called in psychiatry. In each patient, parabulia is expressed individually and can be very diverse. For example, one can quit his job and walk through the cemetery for several months, making his plans. Another can start counting all the letters “N” in Tolstoy’s work “War and Peace”, and a third can abandon school and wander the streets, collecting animal excrement, and when he comes home, hang them on a stand, just as entomologists do with butterflies .

Now let's look at the productive symptoms of schizophrenia.

1. Auditory pseudohallucinations.

The patient does not perceive the voices that he hears as actually existing, but confidently believes that they are accessible only to him alone, that they are destined for him from above. When describing such voices, patients characterize them not as ordinary voices perceived by the ear, but as heard by the brain.

2. Syndrome of mental automatisms.

Consists of several syndromes.

a) Delusion of persecution. Being in this state, patients can arm themselves in self-defense from imaginary pursuers, so they imagine during this period great danger. Causing harm to anyone who is considered a threat to themselves, or attempting suicide in order to quickly “get rid of it” are not excluded.

b) Delirium of influence.

c) Auditory pseudohallucinations.

d) Mental automatism:

• associative (when the patient is sure that the thoughts in his head do not belong to him, but that someone placed them there, made them).
• senestopathic (when the patient considers his feelings imposed by someone from the outside).
• motor (the patient has the feeling that the movements he makes do not belong to him, but that someone is forcing him to make them).

3. Hebephrenia, catatonia.

This is a state of the patient freezing in one position, often very uncomfortable, for a long time, or the exact opposite state - sudden activity, antics, tomfoolery.

With positive symptoms, in accordance with neurogenetic theories, disconnected work of the cerebral hemispheres and a lack of relationship between the frontal and cerebellar lobes are observed. Pathologies in the functioning of the brain can be easily detected with CT and EEG, where areas that have undergone transformations will be clearly visible, and based on the results a specific diagnosis can be made.

Methods for diagnosing schizophrenia

To make a diagnosis, the detected main positive symptoms are studied in combination with disorders of the emotional-volitional system, which lead to the loss of interpersonal relationships during a cumulative observation of the patient for up to half a year.

A special role in the diagnosis of positive disorders is assigned to the detection of signs of influence on thought processes, behavior and mental disposition, auditory pseudohallucinations, obsessional thought syndromes, resonant disorders of mental activity in the form of interrupted thinking, and motor pathologies.

If we talk about deficit deviations, then, first of all, they focus on the decline in the emotional background, decrease in social activity, hostility towards others, isolation and loss of connections with contact persons, coldness and detachment.

One of the following symptoms must be present:

• insertion and withdrawal of thoughts into the patient’s head, their accessibility, as well as their sound - the “echo” of one’s own thoughts;
• delusional ideas characterized by inadequacy, absurdity and grandiosity of scale;
• delirium of influence and perception, characterized by motor, ideational and sensory automatisms;
• somatic hallucinations, as well as commentary and auditory pseudohallucinations.

Or at least two of the following signs:

• chronic hallucinations (lasting more than a month), accompanied by delusions, but without obvious affect;
• brokenness of expressions, shperrungs and neologisms;
• behavior with catonic manifestations;
• deficiency symptoms, including emotional instability, apathy, poverty of speech, abulia;
• significant changes in behavior, characterized by loss of interests, autism, lack of purpose.

Paranoid form Diagnosed by observing the main signs of schizophrenia in combination with the following symptoms:

• the predominance of delusional or hallucinatory disorders (obsessions of origin, relationship, persecution, exchange of thoughts, hallucinations of taste and smell, haunting and frightening voices);
• Catanic signs, inadequate affect, fragmented speech can be observed in a mild form, without predominant in the general clinical diagnosis.

Hebephrenic form diagnosed against the background of the main symptoms of schizophrenia in combination with one of the following:

• obvious and prolonged inadequacy of affect;
• obvious and prolonged superficiality of affect.

Or in combination with one of the other two signs:

• there is no composure and purposefulness in behavior;
• obvious thinking disorders, expressed by broken and incoherent speech.

Delusional-hallucinatory disorders also occur in a mild form, but in general, do not affect the clinical picture of the disease.

Catatonic form diagnosed on the basis of the main signs of schizophrenia in addition to one of the following symptoms for at least two weeks:

• stupor (there is a clear decrease in reaction to what is happening around, sudden activity and mobility) or mutism;
• excitement (visually inadequate motor activity not caused by external stimuli);
• stereotypies (repetition of stereotypical motor elements, voluntary adoption and preservation of pretentious and inappropriate poses);
• negativism (visually unreasonable opposition to third-party requests, performing actions opposite to those required);
• rigidity (maintaining a pose despite attempts to change it from the outside);
• waxy flexibility (freezing of the body or limbs in poses specified from the outside);
• automaticity (immediate fulfillment of requirements).

Diagnosis undifferentiated form is placed when the patient’s condition fits the main indicators of schizophrenia, but does not meet the criteria for individual specific types, or the symptoms are so diverse that they fit several subtypes simultaneously.

Postschizophrenic depression diagnosed when several conditions are met:

• the patient’s condition over the last year of observation falls under the main criteria for schizophrenia;
• at least one of the indicators of schizophrenia is preserved;
• manifestation depressive syndrome should be so long, clear and voluminous that it meets the criteria for at least a mild depressive state.

Residual schizophrenia Diagnosed subject to the presence in the past of the corresponding main symptoms of schizophrenia, which were no longer detected during the examination. And over the past year, at least four deficit indicators from the following list must be observed:

• decreased social activity and attention to one’s appearance;
• decreased motor activity and psychomotor retardation;
• decreased manifestation of nonverbal connections, which are reflected in facial expressions, gestures, visual contact, and speech modulations;
• obvious flatness of affect;
• paucity of content and volume of speech;
• decreased manifestations of initiative and passivity;

Simple form of schizophrenia is diagnosed based on the following indicators, a gradual increase in which is observed for at least a year:

• obvious and stable metamorphoses of some personal characteristics of the patient, which are expressed in a decrease in interests and motivations, meaningfulness and effectiveness of behavior, in isolating oneself from the outside world;
• negative symptoms: passivity, apathy, paucity of speech, decreased level of activity, pronounced flatness of affect, lack of initiative, decreased non-verbal methods of communication;
• a clearly expressed decline in performance in studies or work discipline;
• there are no characteristic manifestations of dementia or signs of any other brain damage;
• in catatonic, undifferentiated, paranoid, hebephrenic forms of schizophrenia, the patient’s condition rarely corresponds to the general symptoms.

The diagnosis is also confirmed by the results of pathopsychological analysis, and genetic data on the likelihood of close (first degree) relatives having schizophrenia are also of secondary importance.

Pathopsychological studies in schizophrenia.

Alas, screening of patients with mental illnesses is not very popular in Russia. Despite the fact that there are medical psychologists on staff at hospitals.

Conversation seems to be a possible main method of diagnosis. Logical sequence thought processes, inherent in a healthy person, is upset in most schizophrenics, and associative processes are disrupted. The result of such pathologies is the patient’s seemingly consistent speech, but with a lack of semantic load between the words of this speech. An example is the following sentence: “The sages of the laws of justice are hunting for me in order to scatter the crooked-nosed lambs all over the world.”

When testing patients, they are asked to clarify their understanding of sayings and expressions with a figurative meaning. It is with this method that one can determine earthiness, literal thinking, identify the absence of logical processes, and the inability to understand judgments with a figurative meaning. For example, what judgments can be heard in response to “the forest is being cut down, the chips are flying”? The reasoning of one of the patients has approximately the following meaning - yes, wood consists of fibers, so when hit with an ax they break off and fly apart. Another patient was asked to comment on the phrase “a man with a heart of stone.” In response, the patient explained that among the times there is a growth value of the cardiac layer, and this is the appearance of human growth. As we can see for ourselves, both expressions are devoid of any meaning and are not understandable to the average person. This is a vivid example of fragmentation and meaninglessness of speech.

For a number of cases, it is generally normal to reduce speech to the pronunciation of individual words and expressions, without any sequence at all. For example, “the kingdom of heaven... will not be anywhere... pouring out smoke... six crowns... buying water is wrong... a division of two without a name... a lasso and a cross...” This is just a set of individual phrases, or a verbal vinaigrette.

The patient may also be asked to depict the meaning of a “delicious lunch.” Naturally, a mentally healthy person would most likely depict a juicy part of a chicken carcass, a plate of hot soup with cutlery. But the schizophrenic has his own vision of such a phrase - he draws two ordinary parallel lines. And when asked what he depicted, he will answer that in his vision it is just a delicious lunch, everything is high, and harmonious, just like the drawn lines.

Another test can be to exclude the fourth extra person from the listed row. For example, from the list “jackdaw, plane, crow, tit,” the patient may either not choose a plane from the list, because all the objects on the list fly, or his choice will fall on an object that he will exclude, relying only on obvious signs ( The logic may be as follows - some of the list is capable of sitting on wires, but the plane is not. But it is correct to be guided by the living/nonliving principle, as most people would do in common sense).

Tests for schizophrenia

An important place in the diagnosis of the disease is given to tests for schizophrenia. Due to the fact that the disease is very specific and cannot be detected using standard medical methods, tests in most cases provide the only opportunity to identify it.

Dozens of years have been spent developing tests. Some, due to their lack of demand, have not been used for a long time, while others were developed relatively recently and are very effective. The “Mask” test is one of the latter. The patient is shown a picture of a mask, or rather, it inside– concave towards the viewer. In a healthy brain normal person the picture is immediately analyzed - the roundness of the shapes, the presence of shadows, etc. Therefore, the mask appears convex to him (although in fact it is not). For patients with schizophrenia, such a visual illusion is not noticeable, and the mask for his brain is concave. This means that the schizophrenic ignores accompanying signals, and even if he notices them, he does not connect them in any way with the visible image. Simply put, there is no clear relationship between objects and phenomena. And having selected only the mask from the overall picture, he states that it is concave.

The Luscher color test, of which there are many variations, is another common test. To carry it out, a palette of eight different colors is prepared, which are assigned serial numbers. The patient is asked to arrange the colors in the order how much he likes each of them. It is important to conduct the test in natural light during the daytime so that the light is distributed evenly without sun spots or glare. Regardless of any external factors, the patient must choose colors based on his personal preferences.

The experimental technology is very simple - the patient chooses colors completely unconsciously. If with other types of testing there are options on how to proceed, here deception is practically excluded. By choosing colors, patients provide more reliable information. As long-term practice shows, a special place in the minds of people with mental disorders takes yellow, so it is deservedly called the color of madness. In addition to deciphering the test results, the doctor should note what color scheme the patient is wearing and what palette he prefers when drawing. Patients' clothes are rarely distinguished by brightness and a variety of colors; they prefer dull shades and do not bother combining them with each other. In the picture depicted by a schizophrenic, in most cases unnatural combinations will be observed (for example, black Sun or red grass) and incorrect application of shadows. Against the background of the general nondescriptness of the picture, a bright spot may suddenly appear. Such drawings indicate thinking processes. To a schizophrenic, the world seems one-sided, lacking color and flat. The flashes shown in the pictures indicate seizures.

In literary works on psychiatry one can find descriptions of color variants of many combinations for different schizophrenic forms. For example, a signal of mania is the color red applied over a large area. Small inclusions of different colors characterize the emotional outbursts of the patient. The color black indicates depression, fears and difficult emotional experiences. Visions from hallucinations, as a rule, are displayed in red, and hallucinations and delusions associated with religious themes are reproduced in white, because schizophrenics can see the Universe and God as white spots, etc.

In addition to the colors that schizophrenics reproduce, it is worth talking about those that they are able to perceive. Most often, patients are either completely indifferent to paints or are irritated by some of them. People suffering from schizophrenia with a sluggish form are often apathetic towards colors, name them indifferently, and are easily confused, as if this is in the order of things. Patients with progressive symptoms are irritated by black and red colors.

Prognosis for schizophrenia

There are only 4 types of forecast, we will reveal each:

1. General prognosis of the disease. Associated with the characteristics and time of onset of the final state.

2. Social and labor forecast.

3. Prognosis of the effectiveness of therapy (whether the disease is resistant to treatment).

4. Prognosis of suicide (suicide) and homicide (murder).

In total, about 40 factors have been identified that help predict the course of the disease. Let's look at some of them.

1. Gender.

The male sex is unfavorable, the female sex is favorable (because at the genetic level it is laid down that the purpose of a woman is to preserve the population, and men are essentially researchers, and therefore are susceptible to large mutations).

2. A poor prognosis is the presence of concomitant pathologies.

3. Unfavorable prognosis – hereditary history of schizophrenia.

4. Schizoid accentuation preceding the disease.

5. Acute onset of the disease - good sign; “smeared”, unclear – bad.

6. Psychogenic cause diseases – good; sudden, causeless - bad.

7. The predominance of affective signs is good; hallucinatory – bad.

8. Positive dynamics towards therapy at the initial stage is good, no - bad.

9. Increased and prolonged hospitalization is a negative indicator.

10. Quality of first remissions.

If they go away completely, that’s good (this means remissions that occur after the initial episodes). The absence or presence of minimal negative and positive symptoms during remissions is of great importance.

About 40 percent of patients with schizophrenia make suicide attempts, and 10-12 percent manage to complete their attempts with a positive result.

Risk factors for possible suicide in schizophrenia are the following:

1. Male gender.

2. Young age.

3. Intellectual development.

4. First time.

5. History of diagnosis of suicide.

6. An overwhelming number of anxiety and depressive symptoms.

7. Imperative hallucinosis (hallucinations requiring one to perform certain actions).

8. Use of psychoactive substances (drugs, alcohol).

9. The first three months after discharge.

11. Problems in society caused by the disease.

Risk factors for possible attempted murder in schizophrenia include the following:

1. Previous episodes of criminal attack described in the anamnesis.

2. Other acts of a criminal nature.

3. Male gender.

4. Young age.

5. Use of psychoactive substances (drugs, alcohol).

6. Hallucinatory-delusional symptoms.

7. Impulsivity of behavior.

Sluggish and recurrent schizophrenia

According to statistical reports, about half of schizophrenics suffer from the disease in its sluggish form. This group of people is very difficult to define. You can also find a recurrent form of schizophrenia. Next we will talk about them.

So, as follows from the definition, low-grade schizophrenia - this is one of its forms, which does not show obvious progression and manifest psychotic manifestations; the clinic appears to be mild personality disorders, derealization, depersonalization and asthenia.

Synonyms for sluggish schizophrenia used in psychiatry are non-psychotic, mild, occurring without a change in character, hidden, slow-flowing, maneuvered, prephase, microprocessual, rudimentary. In addition, there are such names as non-regressive, outpatient, failed, occult, amortized, pseudo-neurotic.

It goes through several specific stages in its development:

1. Latent (debut).

It goes on very secretly and calmly. Mainly in adolescents during their puberty.

2. Active (manifest).

This stage in its development never reaches a psychotic state.

3. Stabilization.

As a rule, it coincides with the first year of the disease, or several years later. In this case, there are no pathologies; there may even be a decline in negative symptoms, its opposite development. But in the interval of involutionary age (45-55 years) a new push may occur.

Distinctive features of this stage:

• slow progression of the stages of the disease over many years (but there are known cases of stabilization at an earlier age);
• a very protracted course of the disease until the first signs appear in the latent stage;
• smooth weakening of disorders at the stabilization stage.

Forms of low-progressive schizophrenia:

1. Asthenic.

The mildest degree. Among the symptoms, only asthenic disorders are observed. The form of asthenia is atypical, without an obvious irritant, and a selective decrease in psychoactivity is characteristic.

The patient experiences fatigue from familiar everyday communication and everyday activities, while he is not exhausted by other activities (for example, collecting, communicating with antisocial individuals). This is a peculiar form of hidden schism, fragmentation of psychoactivity.

2. With obsession.

This form is similar to obsessive-compulsive neurosis. But, even with a great desire, in schizophrenia we are not able to ascertain personal conflict and psychogenesis. Obsessions are monotonous in nature without emotional richness. Moreover, obsessions can be accompanied by numerous rituals without the emotional participation of the patient.

3. With hysterical manifestations.

Characterized by selfish, cold hysterics. So rude and strong that they surpass the hysteria of neurotics. And the more brutal the hysteria, the more serious and profound the disorders.

4. With depersonalization.

Violation of the “I – ​​not I” boundaries during the stages of human development can only be considered as a norm of behavior during adolescence, and in the presence of a disease it goes far beyond these limitations.

5. With dysmorphomanic experiences.

Experiences like “I’m too fat/skinny, my ribs stick out too much, my body is ugly,” etc. This behavior is also typical for adolescence. The difference between schizophrenia is the lack of emotional interest in such worries. Contrived physical defects are pretentious. This group also includes the symptom anorexia nervosa at a young age.

6. Hypochondriacal.

Typical for such age groups, both teenage and involutional. This is a non-psychotic and non-delusional form of schizophrenia.

7. Paranoid.

This form of schizophrenia is similar to paranoid deviation of a person.

8. With the overwhelming majority of affective disorders.

Possible hypothymic manifestations (subdepression, but without intellectual inhibition). In this case, a schism is often noticeable between the reduced level of mood and the mental, motor activity of the volitional element. Hypochondriacal subdepression with an abundance of senestopathies is also observed. Subdepression with a desire for introspection and self-criticism.

Hyperthymic manifestations: hypomania with a one-sided type of passion for any one activity. Zigzag behavior is typical - a person is engaged in work, full of optimism, suddenly falls into a slump for a couple of days, and then works again. Schisic variant - hypomania accompanied by health complaints.

9. Form of non-productive disorders.

A simple option in terms of symptoms, which are limited only to negative symptoms. There is a smooth pathology that intensifies over the years.

10. Latent sluggish schizophrenia.

The totality of all the previously described forms, but in their easiest manifestation.

In the form of sluggish schizophrenia, the following defects may be observed:

1. Ferschroben type defect.

Translated from German, it symbolizes eccentricity, eccentricity, strangeness. The description belongs to Kraepelen. If we describe the visual symptoms, looking at the patient, there is a clear imbalance in movements, angularity and immaturity, combined with unreasonable concentration of the face.

There are noticeable changes in the character traits acquired before the disease and characteristic of the individual. If we talk about clothes, one can see sloppiness and absurdity (randomly dressed things, flashy hats, short trousers, the style of clothing from the century before last, and the like). Unusual words and peculiar turns of phrase appear in speech, and there is a tendency to focus on unimportant details. There is a preservation of activity, both physical and mental, despite the originality and strangeness (there is a schism between lifestyle and social autism; in simple terms, patients communicate and move around a lot, but do it eccentrically).

2. Psychopathic-like defect.

The description belongs to Smulevich. The dominant element is schizoid. The patient can be characterized as restless, obsessive, spouting super-valuable ideas, active, emotional “autistic inside out”, at the same time superficial, unable to carry out social functions. In addition, a hysterical component may also be observed.

3. Weakening of energy capabilities of an average degree of manifestation.

This category of patients is characterized by its own distinctive features - passivity, concentration of life within the confines of their living space, not wanting to do anything. The manifestation of the defect is similar to the standard reduction of energy potential in schizophrenia, but to a much lesser extent.

Often these individuals begin to use psychoactive substances, mainly alcohol. Moreover, emotional superficiality decreases, the pathology of schizophrenia decreases. However, the threat is that drug and alcohol addiction gets out of control, becoming uncontrollable, because their reaction to such substances is atypical. Most often, alcohol does not provide relief, and forms of intoxication are violent, with pronounced aggression and rudeness. Despite this, alcohol in small doses is even recommended for such people (for low-grade schizophrenia, old-school psychiatrists even prescribed it to their patients).

Finally got around to reviewing it recurrent (or periodic) schizophrenia.

It is extremely rare to see this form. In particular, precisely because its timely diagnosis is not always possible. In accordance with the International Classification of Diseases, this form of schizophrenia is designated as schizoaffective disorder. In its structure and symptoms it is a more complex form of schizophrenia.

So, the stages of manifestation of recurrent schizophrenia:

1. The initial stage of general somatic and affective disorders.

It is subdepression with obvious somatization - weakness, constipation, anorexia. Characterized by the manifestation of real, but largely exaggerated, fears for relatives and work. It can last from a couple of days to 1-3 months. This is how it could all end.

As a rule, it begins in adolescence.

2. Delusional affect.

The condition is accompanied by vague, brief anxieties of a paranoid or delusional nature for oneself and loved ones. Delusional ideas are few in number, fragmentary, but rich in emotions and motor components. Therefore, it can be compared with acute paranoid syndrome.

This state is characterized by incipient transformations of self-awareness. A kind of rejection of one’s usual behavior occurs, and depersonalization disorders of medium depth are observed.

3. Stage of affective-delusional depersonalization and derealization.

This period is characterized by sharply increasing disorders of self-awareness and the emergence of a delusional perception of the environment. Intermetamorphotic delirium like “everything around is a rig.” The symptom of doubles appears, erroneous recognition, automatisms develop, it is noted psychomotor agitation and substupor.

4. Stage of fantastic affective-delusional depersonalization and derealization.

Perception turns into fantastic, unreal, paraphrenization of symptoms occurs. The disorder of self-awareness becomes even worse; a clear understanding comes that the patient is a robot being controlled, or, conversely, the patient thinks that he controls a hospital, a city, for example.

5. Illusory-fantastic derealization and depersonalization.

The perception of the real world and one’s personality begins to suffer severely, hallucinations and illusions appear. In principle, this is the beginning of oneiric stupefaction. For example, the patient is visited by the thoughts “pockets are devices for disks; I am not me, from now on I am a robot; I hear the voice of a policeman, but it is not his voice, but the one who is in charge of everything on Earth.”

6. Stage of classic, true oneiric clouding of consciousness.

This period coincides with a complete disruption of the perception of reality; it is not possible to contact the patient (only short-term due to the instability of the processes).

May appear motor activity, caused by experienced images. Self-awareness is completely destroyed - the patient is no longer a person, but a machine in the confrontation between people and machines, for example.

7. Stage of amentia-like clouding of consciousness.

In comparison with the previous stage, psychopathological experiences become scarce. There is complete amnesia of images and experiences. Also associated with severe catatonic signs, confusion, elevated temperature bodies. This is the pre-phase of the subsequent stage. The prognosis is not good.

At this stage, another form of schizophrenia is distinguished - febrile, the main treatment for which is electroconvulsive therapy, 2-3 procedures per day. This is the only method to bring a person out of such a state. There is a possibility of a possible improvement of 5 percent. And without therapy, the prognosis becomes 99.9 percent unfavorable.

All the stages described can exist as a separate independent disease. Basically, with each new attack, the patient’s well-being worsens until it is fixed at a certain stage. Recurrent schizophrenia is a slowly ongoing form, so the period between exacerbations does not differ from complete recovery. However, remissions are quite long, and the manifestations of the disease are not pronounced.

The most common outcome is a slowdown in energetic processes, patients experience passivity, detachment from the world, but often maintain a warm attitude towards family members.

Recurrent schizophrenia can develop into fur-like schizophrenia after 5-6 years in most patients. To a stable pathology, this form of schizophrenia in pure form does not lead.

Treatment options for schizophrenia

Common methods are:

I. Biological therapy.

II. Social therapy consisting of:

a) psychotherapy;

b) methods of social rehabilitation.

Let's consider biological methods therapy. The methods of shock therapy are based on:

1. Insulin comatose therapy.

The founder of this method in 1933 was Zakel, a German psychotherapist.

2. Convulsive therapy.

The founder of this method in 1934 was Meduna, a Hungarian psychotherapist. The point was to introduce subcutaneous layer camphor oil is not relevant today.

3. Electroconvulsive therapy (ECT).

The founders were psychiatrists Beni and Cerletti in 1937. This method has been successfully used in the treatment of affective disorders; effective in schizophrenia in the treatment of catatonic stupors, suicidal behavior, lack of positive dynamics in the treatment of schizophrenia with medications.

4. Detoxification therapy.

5. Diet-fasting therapy.

Used in the treatment of low-grade schizophrenia.

6. Sleep deprivation techniques and phototherapy.

Used for severe affective disorders.

7. Psychosurgery.

The first lobotomy was performed in 1907. The first prefrontal leucotomy was performed in 1926 by the Portuguese physician Monica, who was subsequently shot with a pistol by his patient for operating on him.

8. Pharmacotherapy.

The following groups of drugs are actively used:

• psychostimulants;
• neuroleptics;
• nootropics;
• anxiolytics (can reduce patient anxiety);
• antidepressants;
• normotimics (able to control the affective sphere).

All groups of these medications are used in the treatment of schizophrenia, but neuroleptics occupy the leading position.

The drug treatment of schizophrenia is guided by certain principles:

1) Biopsychosocial approach.

This principle states that everyone with schizophrenia needs psychotherapy, social rehabilitation and biological treatment.

2) Special attention is given to psychological interaction with the doctor, since it is with him that patients have the most low level contact, because schizophrenics are extremely distrustful and deny their illness.

3) It is better to start therapy as early as possible, before the development of the manifest stage.

4) Monotherapy.

The idea is that if you choose 5 or 3 possible drugs for treatment, stop at three to track the effectiveness of each of them.

5) Duration of treatment:

2 months to relieve symptoms;

6 months to stabilize the condition;

One year to form remission.

6) The role of prevention.

In the treatment of schizophrenia, drug prevention of exacerbations plays a special role. After all, a greater number of exacerbations indicates a more severe course of the disease. In this case, we mean secondary prevention.

The use of neuroleptics is due to the dopamine theory of pathogenesis. It was once believed that schizophrenics had high concentrations of dopamine and should be blocked. However, it was later found that its content is not greater, just that the receptors are more sensitive to it.

Haloperidol is classical standard treatment of schizophrenic disorders. In terms of its potency, it is in no way inferior to the drugs used in further treatment. However, like all drugs, standard antipsychotics have side effects: their use increases the risk of extrapyramidal disorders, and they have a very harsh effect on all dopamine receptors.

Not so long ago, atypical antipsychotics began to appear, the first of which was Clozepine (Leponex), but here is a list of the most popular in modern times:

• Abilefay;
• Respiredon;
• Quetiopine (Serroquel);
• Clozepine;
• Alanzepin.

Currently, longer-acting drugs have been developed and are being successfully used, making it possible to achieve remissions with less frequent use of drugs:

• Rispolept-consta (it is enough to apply once every 2-3 weeks);
• Moditen Depot;
• Haloperidol decanoate.

Upon appointment medication course As a rule, the choice is made towards oral drugs, since intramuscular or intravenous administration is compared to violence and causes maximum concentration in the blood quite quickly. Therefore, such administration of drugs is used primarily to suppress psychomotor agitation.

Hospitalization and inpatient treatment

Hospitalization for schizophrenia is resorted to in cases of acute conditions. For example, if you refuse to eat for a week or more, or if you lose 20% of your initial body weight or more; in cases of manifestation of commanding hallucinosis, in cases of suicide attempts or thoughts about it, in cases of manifestation of aggression in behavior and in a state of psychomotor agitation.

Since citizens with schizophrenia often do not understand that they are sick, it is extremely difficult and almost impossible to persuade them into treatment. However, if the patient’s condition worsens, even if he does not consent to treatment, such patients have to be forcibly hospitalized in psychiatric clinics. The basis of both compulsory hospitalization and the laws regulating it is to ensure the safety of the patient in a state of exacerbation and the people around him. Among other things, hospitalization fulfills another goal - providing timely medical care and treatment of the patient, albeit without his will. After examining the patient and analyzing his mental state, the local psychiatrist decides what the conditions of treatment should be: whether urgent placement in a psychiatric hospital is required, or whether outpatient treatment can be done.

The legislation of the Russian Federation provides for an article regulating the grounds for compulsory placement in a psychiatric hospital, or more precisely, if examination or treatment of a patient is possible exclusively in an inpatient setting, and the mental disorder itself is severe and:

• poses an immediate danger to the patient or others;
• makes the patient helpless, that is, unable to independently satisfy the basic needs of life;
• will cause significant harm to the patient’s health as a result of a deterioration in the mental state if left without psychiatric help.

More details about this can be found in Article 92 of the Law of the Russian Federation as amended in 1992.

Treatment during remission.

For this stage, maintenance therapy is required, without which deterioration of the condition is inevitable.

After discharge, patients generally feel significantly better, and they mistakenly believe that they have been completely healed, consciously stop taking the medications, and everything repeats again. Schizophrenia is a disease that cannot be cured, but with competent and high-quality therapy, it is possible to achieve long-term remission in combination with maintenance therapy.

One should not discount the fact that in most cases, the successful outcome of treatment depends on how soon after the exacerbation or initial stage the patient turned to a psychotherapist for help. Alas, having heard about all the “delights” of psychiatric hospitals, the relatives of such a patient are not supporters of hospitalization, pinning their hopes on the fact that everything will go away on its own. Unfortunately, sudden remissions without treatment intervention were almost never encountered in practice. Therefore, as a result, the patient’s relatives have to turn to doctors, but in a more severe situation with progressive symptoms of the disease.

Remission indicators are:

• disappearance of delusions and hallucinations, if observed;
• disappearance of aggressive behavior or cessation of suicide attempts;
• social adaptation, if possible.

No matter what improvements in the patient’s condition are observed, the decision on discharge is made only by the doctor, just like hospitalization. And the best thing that relatives can do is to cooperate in every possible way with the psychiatrist, notifying him of all the features of the patient’s behavior, naturally, without hiding or exaggerating anything. In addition, relatives must monitor the intake of medications, because patients themselves rarely follow the doctor’s recommendations.

Moreover, the success of the result is also reflected in social rehabilitation, and half of the success lies in creating a comfortable atmosphere for the patient within the family. You can be sure that such patients are very keenly aware of the attitude towards their personality and react in accordance with their feelings.

If we take into account the cost of treatment, the amount of disability payments and sick leave, then schizophrenia can perhaps be distinguished as the most expensive of all mental pathologies.

• Weakness of one's self-identification - there are difficulties in identifying and interpreting those signals that should show a person what type of information a particular sentence belongs to. For example, a patient comes into a hospital cafeteria and the girl behind the counter asks, “How can I help you?” He is not sure what type of information this question should be classified as: is she laughing at him, or inviting him to an intimate acquaintance? He hears words and does not know how to understand them. He is unable to understand the abstract formulations that most of us use on a daily basis.
• Contamination (infection) is an idea of ​​the disease from the point of view of transactional analysis. The adult state of a person is infected (infiltrated) by the ego states of Parent and Child. This gives rise to inconsistencies in behavior and ideas about what is happening, from the spontaneity of the child to the critical and condemning parent. Emotional sphere: simultaneously positive and negative feeling towards a person, object, event, for example, in the attitude of children towards their parents. Volitional sphere: endless fluctuations between opposing decisions, the inability to choose between them, often leading to refusal to make a decision at all. Sphere of thinking: alternation or simultaneous existence of contradictory, mutually exclusive ideas in a person’s reasoning.
• Peculiarities of upbringing in childhood - insufficient emotional connections between mother and child, coldness, inconsistency of mothers of patients with schizophrenia. This hypothesis is put forward by representatives of psychoanalytic psychology.
• The role of stress factors - stress, both psychological and physiological, greatly affects the state of the psyche, and therefore can be a trigger in the development of the disease; Also, taking surfactants can trigger the onset of the disease.
• Age-related crises - often the onset of schizophrenia manifests itself in a period that represents a situation of transition to independent existence from life under the care of parents: from 17-19 years to 20-25 years.

Currently, scientific thought has turned towards the predominance of the psychological theory of the occurrence of schizophrenia, and the relative secondary importance of biological factors.em> This has made it possible to take a completely different look at the therapeutic approach to this group of diseases and the possibility of obtaining complete control over the disease.em>

Main symptoms of schizophrenia

Currently there are following signs schizophrenia:

• productive symptoms: delusions and hallucinations;
• negative symptoms: decreased energy potential, apathy, lack of will;
• cognitive impairments: disorders of thinking, perception, attention and others.

Age: Schizophrenia most often begins in late adolescence or early adulthood.

Diagnosis of schizophrenia

Complaints in schizophrenia are presented in an unusual and pretentious form (the head is filled with ash, the urine is charged with excess electricity, the stomach hurts due to the fact that it is being scanned with a computer...). As well as common complaints common to many mental illness– insomnia, low mood, apathy, anxiety.

Differential diagnosis with other mental illnesses:

• feeling of violent action: delusion of outside influence external forces– there is someone who forces you to perform certain actions;
• the belief that thoughts and ideas are stolen from someone’s head or put into it;
• voicing one’s own thoughts – a person thinks that the content of thoughts becomes accessible to other people;
• voices commenting on a person’s thoughts and actions, or talking to each other.

Stages of treatment:

Treatment of schizophrenic disorders depends on the form of the disease and its course. But basically it takes place in 3 stages:

1. 1. 1. Inpatient treatment: clarification of the diagnosis, relief of acute psychotic symptoms, selection of therapy for outpatient treatment. This stage takes on average 2-4 weeks.
      2. Stabilization of mental state, selection of monotherapy for long-term drug therapy. Physiotherapy and neurometabolic therapy - to improve brain function. The outpatient program is designed for 1-1.5 months, with visits to the clinic 2-3 times a week. Individual psychotherapy - preparation for a psychotherapeutic group for people with an endogenous disease.
      3. Direct psychological and social adaptation through participation in a special therapeutic psychotherapeutic group. Visit once a week. Visitors can participate in an online group via the Internet. Family psychotherapy is psychological training for family members of a person suffering from schizophrenia.

A complex approach

Drug therapy:

Neuroleptics: previously, the classical treatment of schizophrenia was based on the use of drugs aminazine, triftazine, haloperidol, etaprazine... These are outdated medicines are able to suppress productive symptoms: eliminate hallucinatory and delusional states, but they help little in reducing the patient’s energy and in cases of disturbances in attention and thinking. Moreover, they are poorly tolerated, causing narcolepsy even at small dosages, which requires the additional administration of large doses of correctors. Currently, the drugs of first choice in the treatment of schizophrenia are atypical antipsychotics: rispiridone, quintiapine, olanzepine, amisulpiride, which affect both productive and negative symptoms. This is due to their seratoninolytic effect. The drugs are well tolerated and have no toxic effects.

The quality and tolerability of prolongs have also improved - drugs intended to stabilize the condition of patients with schizophrenia and prevent relapses: fluanxol-depot, rispolept-consta, clopixol-depot.

Antidepressants: restore the correct balance of neurotransmitters and thus eliminate the biochemical basis of depression, common symptom schizophrenia. IN last years Selective antidepressants have appeared, they relieve depression and at the same time do not cause lethargy:

Tranquilizers: quickly eliminate symptoms - melancholy, anxiety, fear and their bodily manifestations, improve sleep, calm the patient.

Neurometabolic therapy: This is a treatment aimed at improving metabolism and circulation in brain tissue. For this purpose, the drugs Cerebrolysin, Mildranate, Berlition, Mexidol, Milgama, Nootropil, Cavinton are used. IN modern treatment in schizophrenia, it is given special importance, since the ability to keep the biochemical processes of the brain unchanged improves the quality drug treatment and psychotherapy.

Vitamin therapy: vitamins B, PP (nicotinic acid) and C are the most necessary for proper brain function. Their deficiency leads to dementia, disruption of the production of serotonin from tryptophan and general decline metabolic processes of the brain. Mineral therapy: zinc, magnesium. Fatty acid.

Psychotherapy

In modern psychiatric clinics, great importance is attached to psychological and social rehabilitation of both the patients themselves and their relatives.

The main areas of psychotherapy for people diagnosed with schizophrenia are:

Working with pathological personality formations;

Working through the system of relationships: attitude towards your illness, the need for supportive therapy, relationships in the family and at work; to your position in society;

Gaining social experience: self-identification, self-actualization, showing empathy for other people.

The methods used and the psychotherapeutic approach itself are very different from that of neurotic disorders. Therefore, therapy with endogenous patients is carried out by a specially trained psychiatrist-psychotherapist.

At the first zero stage, individual psychotherapeutic work is carried out, where the patient prepares for work in a group, his personal characteristics, painful changes, the possibility of participating in the group is being discussed.

Group psychotherapy

The dynamics of group work have its stages.

Initially, we spend time increasing the emotionality of our group members and establishing warm, friendly contacts.

At the second stage, participants train to understand other people, to be understandable to them. And also develop adequate stereotypes of behavior in various life situations. Patients continue to practice their communication skills, increase their self-confidence, and overcome their addictions.

The third, more complex level of our therapy is devoted to changing and strengthening social positions destroyed by the disease. A person learns to relate more correctly to his illness and behavioral disorders, eliminates destructive attitudes, and optimizes his social contacts.

And finally, at the 4th stage of group therapy, we pay attention to uncovering and working through internal conflicts, rebuilding broken systems of relationships, and developing adequate forms of psychological compensation. This explains why the use of personal defense mechanisms is not constructive.

Individual and group work for relatives of patients allows them to understand the nature of the disease and find an individual approach to the sick relative. And also to develop a mechanism for including him in intra-family relationships and sharing responsibilities.

Shock therapy

Shock treatments for schizophrenia: Some forms of schizophrenia that are malignant and resistant to therapy can be treated with electroconvulsive and insulin comatose therapy. em> This is extremely effective methods treatment of prolonged psychoses, severe depression, catatonia. But due to the negative attitude of relatives towards them and propaganda in the media as harsh methods of treatment, they currently have limited use. Shock therapy is usually carried out in a specialized hospital or psychiatric intensive care unit.

The patient prepares for the procedure: he is additionally examined, muscle relaxants are administered, and anesthesia is administered.

Shock therapy methods affect not only the symptoms, but also the pathogenesis of schizophrenia.

Additional Methods

Laser irradiation of blood

Light therapy

Color therapy

General massage or massage of the neck-collar area, sulfide and pine baths, underwater massage, circular or ascending shower.

Aromatherapy

Physical education and sports activities

Diet therapy

Patients with schizophrenia are advised to eat foods rich in vitamins and proteins. At acute psychoses a complete refusal to eat is possible. In this case, artificial nutrition is indicated.

Some medical researchers have suggested the pathogenetic role of gluten (a plant protein found in many cereals) and casein (milk protein) in the development of schizophrenia, which leads to excessive accumulation of exorphins in the cerebrospinal fluid and can clinically manifest itself as symptoms of schizophrenia and autism. While this assumption is not

fully proven and disproven, and research in this direction continues.

Experience with special gluten- and casein-free diets does not provide reliable evidence of the therapeutic effectiveness of this method, but further research in this area continues.

Treatment result

The timing of initiation of treatment for schizophrenia plays a huge role.

Treatment is especially effective if:

• it is carried out in the next one to two years after diagnosis,
• an integrated approach is used,
• the patient continues to attend a psychotherapeutic group,
• the patient’s relatives actively participate in his psychological and social rehabilitation.

But even if the disease has existed for a long time, you can significantly help a person suffering from schizophrenia and those close to him.

Duration of treatment: 2-4 weeks – relief of an acute psychotic state: inpatient, or intensive, if the form and course of schizophrenia allows, outpatient treatment.

1-1.5 months – condition stabilization: outpatient program.

1.5-2 years – visiting a psychotherapeutic group for endogenous patients and family psychotherapy for relatives.

Patient

After treatment (Zyprex 40 2 times a day was prescribed for 2 months in the hospital), the condition upon discharge was normal, but a fanatical faith in God and faith in a future marriage with DE CAPRIO remained. Currently, an unstable mental state has appeared; a desire to go to church even at night, what do you think In your opinion, is the dose of treatment insufficient (excessive) or not appropriate when selecting a medicine?

Doctor

It's hard to say now. Judging only by your description, then most likely we are talking about undertreatment. You now require active therapy in a hospital setting. It is necessary to extinguish the existing excitation (overexcitation internal processes brain), which gives such symptoms and at the same time more accurately select further therapy.
I would recommend that you be hospitalized and wait for your condition to normalize. Yes, the hospital is always difficult to endure, but only here can full assistance be provided in such situations, since round-the-clock medical monitoring of the condition is necessary. This will provide the fastest and most safe restoration of the processes of higher nervous activity.

Worldwide, this disease affects about 1% of the total population. Moreover, the risk of developing schizophrenia almost does not depend on the level of education, profession or membership in a certain social class. Living conditions (a big city or, conversely, a rural area) have little effect on this risk.

And vice versa, there are ones whose significance cannot be denied, for example, heredity. But if only it determined the cause of the disease, then, for example, twins who have a completely similar set of chromosomes of hereditary material would always get sick together. However, in life this does not always happen. Another reason, quite popular as an explanation for the disease, is “stress” (“after the army”, “after a breakup with a girlfriend/boyfriend”, “after an injury”, etc.). But, you see, not everyone who served in the army or broke up with a girlfriend or was injured - they became patients of psychiatrists. There are people who have personality traits similar to those of schizophrenia (withdrawal, emotional coldness, “peculiar” thinking, etc.), but they do not necessarily suffer from this disorder.

Such facts give reason to believe that the disease is multifactorial and is based on heredity, individual personality traits, habits and lifestyle, family and social relationships, and, finally, environmental factors. All of the above can be divided into three groups: biological, psychological and social. Only in the case of a violation of all three components does it become possible for what psychiatrists around the world call schizophrenia. That is why the efforts of doctors who try to cure this disease only with medicine are often in vain. The same thing happens when psychoanalysts try to influence a client exclusively through psychological methods. Currently, the most justified and effective is a comprehensive biopsychosocial approach to the treatment of this complex disease.

MANIFESTATIONS OF MENTAL DISORDERS

Many of those who have ever used words such as delusion, hallucinations or psychosis in their speech, including in their address), sometimes do not think that these concepts have a very specific meaning and can characterize the disease that is being discussed here.

Let us explain what some of them mean in the language of psychiatry:

Delirium is a set of ideas and judgments that do not correspond to reality, which completely take over the patient’s consciousness and cannot be corrected by explanation and dissuading. Refers to thinking disorders.

The patient treats his delusional ideas as the only correct ones. All attempts to change his point of view cause protest, distrust or even aggression towards the “unintelligible” interlocutor: “well, and you don’t believe me.” Ideas can be completely absurd and ridiculous, or they can be close to reality, but at the same time occupy an inadequately significant place in the patient’s mind.

Hallucinations are disturbances of perception in the form of sensations and images that arise involuntarily without a real object and acquire the character of objective reality for the patient.

Hallucinations may be perceived by some patients as painful manifestations that are alien to their personality. In this case, they usually seek to get rid of them with the help of medications, especially if they are intrusive or frightening. But often a mentally ill person is so overwhelmed by these experiences that he cannot distinguish between reality and internal painful sensations(sounds, visions, etc.). His behavior and thinking are subordinated to these images, and it is as if he “exists in another world.” For a mentally healthy person, the most understandable comparison may be a dream. In it, completely incompatible, illogical events and actions do not cause us surprise or a feeling of unreality (a person can fly, the dead come to the living, etc.). This is exactly how patients with psychosis perceive their hallucinatory images without questioning them. But unlike healthy people, these images accompany them in reality.

Delusions, hallucinations, psychomotor agitation and extreme degrees of emotional disturbances (mania) are classified as PSYCHOTIC DISORDERS. The conditions in which they occur are called PSYCHOSES. Therefore, schizophrenia belongs to the group of so-called PSYCHOTIC DISEASES. Unlike the next group of symptoms, these disorders are also called positive or productive. This does not speak about their positive qualities, but shows that they “add” something to the conventional norm.

The second group of symptoms, called negative, refers to disorders that “take away” something from this very conventional norm. These include:

Apathy is a lack of interest in anything, indifference to everything, abulia is lack of will, autism is withdrawal, “withdrawal,” emotional coldness, indifference.

The above symptoms can also occur in other diseases, but are most often observed in schizophrenia. In the case of schizophrenia, these disorders are often longer lasting than the psychotic disorders themselves. Until recently (before the advent of a new generation of drugs), these disorders were considered practically irreversible.

There are other, less specific phenomena that may occur not only in schizophrenia. Quite often we hear from patients themselves and their relatives about more common complaints, such as insomnia, irritability, anxiety, loss of appetite, etc. The presence of only these disorders in the disease picture cannot be the basis for a diagnosis of schizophrenia. But their appearance can often be a sign of an incipient exacerbation.

COURSE AND PROGNOSIS OF SCHIZOPHRENIA.

The prognosis for schizophrenia is largely determined by the type of course of the disease. The disease in some cases is limited to one or two psychotic episodes. If a remission then occurs lasting five years or more, this can be regarded as a complete “recovery.” The probability of a new episode of the disease in this case is equal to that of healthy people.

But the disease does not always proceed so favorably - there are cases of prolonged non-remission or continuously alternating exacerbations and remissions.

In both cases, it is possible and necessary to influence the prognosis of the disease and make it more favorable! Strict adherence to the medication regimen is necessary, despite the appearance, at times, of “recovery.” It may not be stable and may not last long without treatment. Schizophrenia in remission is like smoldering coals: it can flare up at any moment. Therefore, maintenance therapy (during remission) is prescribed for several months or even years.

The longer the medications are used during remission, the less likely there is to be a new exacerbation.

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