Schizotypal disorder. Simple form of low-grade schizophrenia

In professional terms, the term " light form "is not entirely correct. This disease can change a person’s personality beyond recognition even in its mildest manifestations. And yet, this phrase can often be found in the anamnesis of patients in psychoneurological clinics. Therefore, it is necessary to explain what is meant by it.

Place in the modern classification of diseases

In the previous international classification of diseases (ICD-9), there was a definition of sluggish (or low-progressive) schizophrenia, which in the current ICD-10 was replaced by the term “schizotypal disorder”. It includes neurosis-like, psychopathic-like, latent schizophrenia and schizotypal personality disorder. Moreover, the latter term is more often used in English-language psychiatric literature than in domestic literature.

Diagnosis of schizotypal disorder or mild form of schizophrenia a psychiatrist can give a patient a diagnosis when he has some characteristic symptoms diseases. However, in terms of their totality and degree of manifestation, they are not enough to make a diagnosis of schizophrenia.

As a rule, such patients do not have clearly defined delusions and hallucinations, or they are rudimentary and are not decisive in the clinical picture of the disease. There is also no progression of the course of the disease, characteristic of more severe forms of schizophrenia, and such pronounced deficit changes do not form.

Symptoms

In order to make a diagnosis such as mild form of schizophrenia, the doctor must ensure that the patient has had 3 or 4 of the following symptoms for at least two years:

• Strangeness, eccentricity in behavior and appearance.
• Views that do not correspond to the dominant culture and religion.
• Tendency to symbolic or magical thinking.
• Thinking disorders are not characterized by pronounced structural changes, but a predominant tendency to fruitless reasoning (reasoning), pretentiousness, and stereotyping prevails.
• Poverty of emotions, inadequate emotional reactions, self-isolation from others.
• Depersonalization and derealization phenomena.
• Obsessive states that the patient does not try to resist.
• Dysmorphophobia predominates (associated with the belief in the presence of a disfiguring physical handicap), hypochondriacal, aggressive and sexual thoughts.
• Suspiciousness (up to ).
• Passivity, lack of initiative, lack of fruitful results from mental activity.

Brad, at mild form of schizophrenia may appear sporadically in a rudimentary form and do not reach the signs of clinically defined psychosis. Sometimes these symptoms can precede the development of severe forms of schizophrenia, most often paranoid.

The outstanding Swiss psychiatrist Eugen Bleuler, who introduced the very term “”, literally meaning “split of the mind” into psychiatric science, believed that there are much more mild and even latent forms of schizophrenia than clearly clinically defined forms. Upon closer examination, many neurotics could fall under this diagnosis. This opinion prevailed in Soviet psychiatry, however, this theory is currently being questioned.

It can be quite difficult to distinguish a psychopathic schizophrenic from a patient suffering from schizoid or paranoid personality disorder. That is, to make a diagnosis of the schizophrenia spectrum, including light form schizophrenia, you need to approach it carefully.

Traditionally, the following forms of schizophrenia have been identified:

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

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

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

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

The following forms of schizophrenia are now also distinguished:

Hebephrenic schizophrenia

Catatonic schizophrenia

Paranoid schizophrenia

Residual schizophrenia (low intensity of positive symptoms)

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

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

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

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

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

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

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

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

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

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

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

Studies of the patterns of development of schizophrenia, conducted at the Department of Psychiatry of the Central Institute for Advanced Medical Studies and at the Scientific Center for Mental Health of the Russian Academy of Medical Sciences under the leadership of A. V. Snezhnevsky, showed the validity of the dynamic approach to the problem of formation and the importance of studying the relationship between the type of course of the disease and its syndromic characteristics at each stage development of the disease.

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

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

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

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

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

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

Classification of forms of schizophrenia

Continuously flowing

Malignant juvenile

Hebephrenic

Catatonic

Paranoid youth

Paranoid

Crazy option

Hallucinatory variant

Sluggish

Paroxysmal-progressive

Malignant

Close to paranoid

Close to sluggish

Recurrent:

With different types of attacks

With the same type of attacks

Special forms

Sluggish

Atypical prolonged pubertal seizure

Paranoid

Febrile

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

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

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

Schizophrenia is equally common among both sexes.

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

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

Psychological characteristics of patients with schizophrenia

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Genetics of schizophrenia

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Literature

1. Depression and depersonalization - Nuller Yu.L. Address: Scientific Center for Mental Health of the Russian Academy of Medical Sciences, 2001-2008 http://www.psychiatry.ru

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

3. M. P. Kononova (Guide to the psychological study of mentally ill children of school age (From the experience of a psychologist in a children's psychiatric hospital). - M.: State Publishing House of Medical Literature, 1963. P.81-127).

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

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General characteristics of schizophrenia

Schizophrenia is a disease belonging to the group of endogenous psychoses, since its causes are due to various changes in the functioning of the body, that is, they are not associated with any external factors. This means that the symptoms of schizophrenia do not arise in response to external stimuli (as with neuroses, hysteria, psychological complexes, etc.), but on their own. It is in this cardinal difference schizophrenia from others mental disorders.

At its core, it is a chronic disease in which a disorder of thinking and perception of any phenomena in the surrounding world develops against the background of a preserved level of intelligence. That is, a person with schizophrenia is not necessarily mentally retarded; his intelligence, like that of all other people, can be low, medium, high, and even very high. Moreover, in history there are many examples of brilliant people who suffered from schizophrenia, for example, Bobby Fischer - world chess champion, mathematician John Nash, who received the Nobel Prize, etc. The story of John Nash's life and illness was brilliantly told in the film A Beautiful Mind.

That is, schizophrenia is not dementia or a simple abnormality, but a specific, completely special disorder of thinking and perception. The term “schizophrenia” itself consists of two words: schizo - to split and phrenia - mind, reason. The final translation of the term into Russian may sound like “split consciousness” or “split consciousness.” That is, schizophrenia is when a person has normal memory and intelligence, all his senses (vision, hearing, smell, taste and touch) work correctly, even the brain perceives all information about the environment as needed, but consciousness (cortex brain) processes all this data incorrectly.

For example, human eyes see green leaves of trees. This picture is transmitted to the brain, assimilated by it and transmitted to the cortex, where the process of understanding the information received occurs. As a result, a normal person, having received information about green leaves on a tree, will comprehend it and conclude that the tree is alive, it’s summer outside, there’s shadow under the crown, etc. And with schizophrenia, a person is not able to comprehend information about green leaves on a tree, in accordance with the normal laws characteristic of our world. This means that when he sees green leaves, he will think that someone is painting them, or that this is some kind of signal for aliens, or that he needs to pick them all, etc. Thus, it is obvious that in schizophrenia there is a disorder of consciousness, which is not able to form an objective picture from the available information based on the laws of our world. As a result, a person has a distorted picture of the world, created precisely by his consciousness from the initially correct signals received by the brain from the senses.

It is precisely because of such a specific disorder of consciousness, when a person has knowledge, ideas, and correct information from the senses, but the final conclusion is made with a chaotic use of its functionalities, the disease was called schizophrenia, that is, splitting of consciousness.

Schizophrenia - symptoms and signs

Indicating the signs and symptoms of schizophrenia, we will not just list them, but also explain in detail, including with examples, what exactly is meant by this or that formulation, since for a person far from psychiatry, it is the correct understanding of the specific terms used to designate symptoms is cornerstone to get an adequate idea of ​​the subject of conversation.

First, you should know that schizophrenia has symptoms and signs. Symptoms mean strictly defined manifestations characteristic of the disease, such as delusions, hallucinations, etc. And signs of schizophrenia are considered to be four areas of human brain activity in which there are disturbances.

Signs of schizophrenia

So, the signs of schizophrenia include the following effects (Bleuler tetrad, four A):

Associative defect – is expressed in the absence of logical thinking in the direction of any final goal of reasoning or dialogue, as well as in the resulting poverty of speech, in which there are no additional, spontaneous components. Currently, this effect is briefly called alogia. Let's look at this effect with an example in order to clearly understand what psychiatrists mean by this term.

So, imagine that a woman is riding on a trolleybus and a friend of hers gets on at one of the stops. A conversation ensues. One of the women asks the other: “Where are you going?” The second one answers: “I want to visit my sister, she’s a little sick, I’m going to visit her.” This is an example of a response from a normal person who does not have schizophrenia. IN in this case, in the second woman’s response, the phrases “I want to visit my sister” and “she’s a little sick” are examples of additional spontaneous components of speech that were said in accordance with the logic of the discussion. That is, the only answer to the question of where she is going is the “to her sister” part. But the woman, logically thinking through other questions of the discussion, immediately answers why she is going to see her sister (“I want to visit because she is sick”).

If the second woman to whom the question was addressed were schizophrenic, then the dialogue would be as follows:
- Where are you driving?
- To Sister.
- For what?
- I want to visit.
- Did something happen to her or just like that?
- It happened.
- What's happened? Something serious?
- I got sick.

Such dialogue with monosyllabic and undeveloped answers is typical for the participants in the discussion, one of whom has schizophrenia. That is, with schizophrenia, a person does not think out the following possible questions in accordance with the logic of the discussion and does not answer them immediately in one sentence, as if ahead of them, but gives monosyllabic answers that require further numerous clarifications.

Autism– is expressed in distraction from the real world around us and immersion in our inner world. A person’s interests are sharply limited, he performs the same actions and does not respond to various stimuli from the surrounding world. In addition, the person does not interact with others and is not able to build normal communication.

Ambivalence – is expressed in the presence of completely opposite opinions, experiences and feelings regarding the same subject or object. For example, with schizophrenia, a person can simultaneously love and hate ice cream, running, etc.

Depending on the nature of ambivalence, three types are distinguished: emotional, volitional and intellectual. Thus, emotional ambivalence is expressed in the simultaneous presence of opposite feelings towards people, events or objects (for example, parents can love and hate children, etc.). Volitional ambivalence is expressed in the presence of endless hesitation when it is necessary to make a choice. Intellectual ambivalence is the presence of diametrically opposed and mutually exclusive ideas.

Affective inadequacy – is expressed in a completely inadequate reaction to various events and actions. For example, when a person sees someone drowning, he laughs, and when he receives some good news, he cries, etc. In general, affect is the external expression of the internal experience of mood. Respectively, affective disorders– these are external manifestations that do not correspond to internal sensory experiences (fear, joy, sadness, pain, happiness, etc.), such as: laughter in response to the experience of fear, fun in grief, etc.

Data pathological effects are signs of schizophrenia and cause changes in the personality of a person who becomes unsociable, withdrawn, loses interest in objects or events that previously worried him, commits ridiculous acts, etc. In addition, a person may develop new hobbies that were previously completely atypical for him. As a rule, such new hobbies in schizophrenia become philosophical or orthodox religious teachings, fanaticism in following any idea (for example, vegetarianism, etc.). As a result of personality restructuring, a person’s performance and degree of socialization are significantly reduced.

In addition to these signs, there are also symptoms of schizophrenia, which include single manifestations of the disease. The entire set of symptoms of schizophrenia is divided into the following large groups:

• Positive (productive) symptoms;
• Negative (deficient) symptoms;
• Disorganized (cognitive) symptoms;
• Affective (mood) symptoms.

Positive symptoms of schizophrenia

Positive symptoms include symptoms that were previously healthy person there were none and they appeared only with the development of schizophrenia. That is, in this case the word “positive” is not used to mean “good”, but only reflects the fact that something new has appeared. That is, there has been a certain increase in the qualities inherent in man.

Positive symptoms of schizophrenia include the following:

• Rave;
• Hallucinations;
• Illusions;
• State of excitement;
• Inappropriate behavior.

Illusions represent an incorrect vision of a truly existing object. For example, instead of a chair, a person sees a closet, and perceives a shadow on the wall as a person, etc. Illusions should be distinguished from hallucinations, since the latter have fundamentally different characteristics.

Hallucinations are a violation of the perception of surrounding reality using the senses. That is, hallucinations mean certain sensations that do not exist in reality. Depending on which sense organ the hallucinations concern, they are divided into auditory, visual, olfactory, tactile and gustatory. In addition, hallucinations can be simple (individual sounds, noise, phrases, flashes, etc.) or complex (coherent speech, certain scenes, etc.).

The most common are auditory hallucinations, when a person hears voices in his head or in the world around him, sometimes it seems to him that thoughts were not produced by him, but embedded in the brain, etc. Voices and thoughts can give commands, advise something, discuss events, speak vulgarities, make people laugh, etc.

Visual hallucinations develop less frequently and, as a rule, in combination with hallucinations of other types - tactile, gustatory, etc. It is the combination of several types of hallucinations that provides a person with the substrate for their subsequent delusional interpretation. Thus, some unpleasant sensations in the genital area are interpreted as a sign of rape, pregnancy or illness.

It should be understood that for a patient with schizophrenia, his hallucinations are not a figment of the imagination, but he really feels it all. That is, he sees aliens, atmosphere control threads, smells roses from cat litter and other non-existent things.

Rave is a set of certain beliefs, conclusions or conclusions that are completely untrue. Delusions can be independent or provoked by hallucinations. Depending on the nature of the beliefs, delusions of persecution, influence, power, greatness or relationship are distinguished.

The most common delusion of persecution develops, in which a person thinks that someone is chasing him, for example, aliens, parents, children, police, etc. Every small event in the environment seems to be a sign of surveillance, for example, tree branches swaying in the wind are perceived as a sign of observers lying in ambush. The person we meet with glasses is perceived as a liaison who is coming to report all his movements, etc.

Delusions of influence are also very common and are characterized by the idea that a person is being affected by some kind of negative or positive influence, for example, DNA rearrangement, radiation, suppression of will by psychotropic weapons, medical experiments, etc. In addition, with this form of delusion, a person is sure that someone controls his internal organs, body and thoughts, putting them directly into his head. However, the delusion of influence may not take such vivid forms, but masquerade as forms quite similar to reality. For example, a person every time gives a piece of cut sausage to a cat or dog, because he is sure that they want to poison him.

Delusion of dysmorphophobia is a persistent belief in the presence of shortcomings that need to be corrected, for example, straightening protruding ribs, etc. The delusion of reformism is the constant invention of some new powerful devices or systems of relationships, which in reality are unviable.

Inappropriate behavior represents either naive stupidity, or strong agitation, or inappropriate manners and appearance for the situation. Typical types of inappropriate behavior include depersonalization and derealization. Depersonalization is a blurring of the boundaries between me and not me, as a result of which one’s own thoughts, internal organs and body parts seem not to be one’s own, but brought from outside, random people are perceived as relatives, etc. Derealization is characterized by an increased perception of any minor details, colors, smells, sounds, etc. Because of this perception, it seems to a person that everything is not happening for real, but that people, like in a theater, play roles.

The most severe type of inappropriate behavior is catatonia, in which a person takes awkward poses or moves erratically. A person in a stupor usually takes awkward poses and holds them for a very long time. Any attempt to change his position is useless, since he puts up resistance that is almost impossible to overcome, because schizophrenics have incredible muscle strength. A special case of awkward postures is waxy flexibility, which is characterized by holding any part of the body in one position for a long time. When excited, a person begins to jump, run, dance and make other meaningless movements.
Also included in the variant of inappropriate behavior is hebephrenia– excessive foolishness, laughter, etc. A person laughs, jumps, laughs and performs other similar actions, regardless of the situation and location.

Negative symptoms of schizophrenia

Negative symptoms of schizophrenia represent previously existing functions that have disappeared or been significantly reduced. That is, before the disease a person had certain qualities, but after the development of schizophrenia they either disappeared or became significantly less pronounced.

In general, negative symptoms of schizophrenia are described as loss of energy and motivation, decreased activity, lack of initiative, poverty of thoughts and speech, physical passivity, emotional poverty and a narrowing of interests. A patient with schizophrenia appears passive, indifferent to what is happening, taciturn, motionless, etc.

However, with a more precise identification of symptoms, the following are considered negative:

• Passivity;
• Loss of will;
• Complete indifference to the outside world (apathy);
• Autism;
• Minimal expression of emotions;
• Flattened affect;
• Slow, sluggish and stingy movements;
• Speech disorders;
• Thinking disorders;
• Inability to make decisions;
• Inability to maintain normal coherent dialogue;
• Low ability to concentrate;
• Rapid depletion;
• Lack of motivation and lack of initiative;
• Mood swings;
• Difficulty in constructing an algorithm for sequential actions;
• Difficulty finding a solution to a problem;
• Poor self-control;
• Difficulty switching from one type of activity to another;
• Ahedonism (inability to experience pleasure).

Due to lack of motivation, schizophrenics often stop leaving the house and do not perform hygienic manipulations(they don’t brush their teeth, don’t wash, don’t take care of their clothes, etc.), as a result of which they acquire a neglected, sloppy and repulsive appearance.

The speech of a person suffering from schizophrenia is characterized by the following features:

• Constantly jumping on different topics;
• The use of new, invented words that are understandable only to the person himself;
• Repeating words, phrases or sentences;
• Rhyming – speaking in meaningless rhyming words;
• Incomplete or abrupt answers to questions;
• Unexpected silences due to blockage of thoughts (sperrung);
• A rush of thoughts (mentism), expressed in rapid, incoherent speech.

Autism represents a person’s separation from the world around him and immersion in his own little world. In this state, the schizophrenic seeks to avoid contact with other people and live alone.

Various disorders of will, motivation, initiative, memory and attention are generally called depletion of energy potential , because a person gets tired quickly, cannot perceive new things, poorly analyzes the totality of events, etc. All this leads to a sharp decrease in the productivity of his activities, as a result of which, as a rule, he loses his ability to work. In some cases, a person develops an extremely valuable idea, which consists in the need to preserve strength, and which manifests itself in a very careful attitude towards one’s own person.

Emotions in schizophrenia become weakly expressed, and their spectrum is very poor, which is usually called flattened affect . First, the person loses responsiveness, compassion and the ability to empathize, as a result of which the schizophrenic becomes selfish, indifferent and cruel. In response to various life situations, a person can react in a completely atypical and incongruous manner, for example, be absolutely indifferent to the death of a child or be offended by an insignificant action, word, look, etc. Very often a person can experience deep affection and submit to one close person.

As schizophrenia progresses, flattened affect can take on unique forms. For example, a person can become eccentric, explosive, unrestrained, conflictual, angry and aggressive, or, on the contrary, acquire complacency, euphoric high spirits, stupidity, uncriticality of actions, etc. With any variant of flattened affect, a person becomes sloppy and prone to gluttony and masturbation.

Thinking disorders are manifested by illogical reasoning and incorrect interpretation of everyday things. Descriptions and reasoning are characterized by so-called symbolism, in which real concepts are replaced by completely different ones. However, in the understanding of patients with schizophrenia, it is precisely these concepts that do not correspond to reality that are symbols of certain real things. For example, a person walks naked, but he explains it this way: nakedness is needed to remove a person’s stupid thoughts. That is, in his thinking and consciousness, nudity is a symbol of liberation from stupid thoughts.

A special variant of thinking disorder is reasoning, which consists of constant empty reasoning on abstract topics. Moreover, the final goal of the reasoning is completely absent, which makes it meaningless. In severe cases, schizophrenia may develop schizophasia, which is the utterance of unrelated words. Patients often combine these words into sentences, observing the correctness of cases, but they do not have any lexical (semantic) connection.

With a predominance of suppressed will in the negative symptoms, a schizophrenic easily falls under the influence of various sects, criminal groups, and asocial elements, obeying their leaders unquestioningly. However, a person may retain a will that allows him to perform some meaningless action to the detriment of normal work and social interaction. For example, a schizophrenic can draw up a detailed plan of a cemetery with the designation of each grave, count the number of any letters in one or another literary work etc.

Agedonia represents the loss of the ability to enjoy anything. Thus, a person cannot eat with pleasure, walk in the park, etc. That is, against the background of anhedonia, a schizophrenic, in principle, cannot receive pleasure even from those actions, objects or events that previously gave him pleasure.

Disorganized symptoms

Disorganized symptoms are a special case of productive symptoms because they include chaotic speech, thinking and behavior.

Affective symptoms

Affective symptoms are various options decreased mood, for example, depression, suicidal thoughts, self-blame, self-flagellation, etc.

Typical syndromes characteristic of schizophrenia

These syndromes are formed only from positive or negative symptoms, and represent the most common combinations of manifestations of schizophrenia. In other words, each syndrome is a collection of the most frequently combined individual symptoms.

So, to standard positive syndromes schizophrenia includes the following:

• Hallucinatory-paranoid syndrome – characterized by a combination of unsystematized delusional ideas (most often persecution), verbal hallucinations and mental automatism (repetitive actions, the feeling that someone is controlling thoughts and body parts, that everything is not real, etc.). All symptoms are perceived by the patient as something real. There is no feeling of artificiality of feelings.
• Kandinsky-Clerambault syndrome – refers to a type of hallucinatory-paranoid syndrome and is characterized by the feeling that all visions and disorders of a person are violent, that someone created them for him (for example, aliens, Gods, etc.). That is, it seems to a person that they are putting thoughts into his head and controlling his internal organs, actions, words and other things. Episodes of mentalism (influx of thoughts) occur periodically, alternating with periods of withdrawal of thoughts. As a rule, there is a completely systematized delusion of persecution and influence, in which a person explains with complete conviction why he was chosen, what they want to do to him, etc. A schizophrenic with Kandinsky-Clerambault syndrome believes that he does not control himself, but is a puppet in the hands of persecutors and evil forces.
• Paraphrenic syndrome – characterized by a combination of persecutory delusions, hallucinations, affective disorders and Kandinsky-Clerambault syndrome. Along with ideas about persecution, a person has a clear conviction of his own power and control over the world, as a result of which he considers himself the ruler of all Gods, solar system etc. Under the influence of his own delusional ideas, a person can tell others that he will create paradise, change the climate, transfer humanity to another planet, etc. The schizophrenic himself feels himself in the center of grandiose, allegedly occurring events. Affective disorder consists of a constantly elevated mood up to a manic state.
• Capgras syndrome- characterized by the delusional idea that people can change their appearance to achieve certain goals.
• Affective-paranoid syndrome – characterized by depression, delusional ideas of persecution, self-accusation and hallucinations with a strong accusatory character. In addition, this syndrome may be characterized by a combination of delusions of grandeur, noble birth and hallucinations of a laudatory, glorifying and approving nature.
• Catatonic syndrome – characterized by freezing in a certain position (catalepsy), giving parts of the body some uncomfortable position and maintaining it for a long time (waxy mobility), as well as strong resistance to any attempts to change the adopted position. Mutism may also be observed - muteness with intact speech apparatus. Any external factors, such as cold, humidity, hunger, thirst and others, cannot force a person to change his absent facial expression with almost completely absent facial expressions. In contrast to freezing in a certain position, agitation may appear, characterized by impulsive, senseless, pretentious and mannered movements.
• Hebephrenic syndrome – characterized by goofy behavior, laughter, mannerisms, grimacing, lisp, impulsive actions and paradoxical emotional reactions. A combination with hallucinatory-paranoid and catatonic syndromes is possible.
• Depersonalization-derealization syndrome – characterized by painful and extremely unpleasant feelings about changes in one’s own personality and the behavior of the surrounding world, which the patient cannot explain.

Typical negative syndromes of schizophrenia are the following:

• Thought disorder syndrome – manifests itself in diversity, fragmentation, symbolism, blockage of thinking and reasoning. Diversity of thinking is manifested by the fact that insignificant features of things and events are perceived by a person as the most important. The speech is detailed with a description of details, but vague and unclear regarding the general main idea of ​​the patient’s monologue. Disruption of speech is manifested by the fact that a person constructs sentences from words and phrases unrelated in meaning, which, however, are grammatically connected by the correct cases, prepositions, etc. A person cannot complete a thought because he constantly deviates from the given topic by association, jumps to other topics, or begins to compare something incomparable. In severe cases, fragmented thinking is manifested by a stream of unrelated words (verbal hash). Symbolism is the use of a term as a symbolic designation for an entirely different concept, thing, or event. For example, with the word stool, the patient symbolically designates his legs, etc. Blocked thinking is a sudden break in the thread of thought or loss of the topic of conversation. In speech, this is manifested by the fact that a person begins to say something, but abruptly falls silent, without even finishing the sentence or phrase. Reasoning is sterile, lengthy, meaningless, but numerous reasoning. In speech, a person with schizophrenia may use their own made-up words.
• Syndrome emotional disturbances – characterized by fading reactions and coldness, as well as the appearance of ambivalence. People lose emotional connections with loved ones, losing compassion, pity and other similar manifestations, becoming cold, cruel and insensitive. Gradually, as the disease progresses, emotions disappear completely. However, it is not always the case that a patient with schizophrenia who does not show emotions is completely absent. In some cases, a person has a rich emotional spectrum and is extremely burdened by the fact that he is not able to fully express it. Ambivalence is the simultaneous presence of opposite thoughts and emotions in relation to the same object. The consequence of ambivalence is the inability to accept final decision and make a choice from possible options.
• Disorder of will syndrome (abulia or hypobulia) – characterized by apathy, lethargy and lack of energy. Such disorders of the will cause a person to isolate himself from the outside world and withdraw into himself. At severe violations of will, a person becomes passive, indifferent, lacking initiative, etc. Most often, disorders of the will are combined with those in the emotional sphere, so they are often combined into one group and called emotional-volitional disorders. For each individual person, the clinical picture of schizophrenia may be dominated by volitional or emotional disturbances.
• Personality change syndrome is the result of the progression and deepening of all negative symptoms. A person becomes mannered, ridiculous, cold, withdrawn, uncommunicative and paradoxical.

Symptoms of schizophrenia in men, women, children and adolescents

Schizophrenia at any age in both sexes manifests itself with exactly the same symptoms and syndromes, without actually having any significant features. The only thing that needs to be taken into account when determining the symptoms of schizophrenia is age norms and the characteristics of people’s thinking.

The first symptoms of schizophrenia (initial, early)

Schizophrenia usually develops gradually, that is, some symptoms appear first, and then they intensify and are complemented by others. The initial manifestations of schizophrenia are called symptoms of the first group, which include the following:

• Speech disorders. As a rule, a person begins to answer any questions in monosyllables, even those that require a detailed answer. In other cases, it cannot comprehensively answer the question posed. It’s rare that a person is able to answer a question in full detail, but he speaks slowly.
• Agedonia– inability to enjoy any activities that previously fascinated the person. For example, before the onset of schizophrenia, a person loved to embroider, but after the onset of the disease, this activity does not interest him at all and does not give him pleasure.
• Weak expression or complete absence of emotions. The person does not look into the eyes of the interlocutor, the face is expressionless, no emotions or feelings are reflected on it.
• Inability to complete any task , because a person does not see the meaning in it. For example, a schizophrenic does not brush his teeth because he does not see the point in doing so, because they will get dirty again, etc.
• Poor concentration on any subject.

Symptoms of different types of schizophrenia

Currently, based on the syndromes that predominate in the clinical picture, according to international classifications, the following types of schizophrenia are distinguished:
1. Paranoid schizophrenia;
2. Catatonic schizophrenia;
3. Hebephrenic (disorganized) schizophrenia;
4. Undifferentiated schizophrenia;
5. Residual schizophrenia;
6. Post-schizophrenic depression;
7. Simple (mild) schizophrenia.

Paranoid (paranoid) schizophrenia

The person has delusions and hallucinations, but normal thinking and adequate behavior remain. Emotional sphere at the beginning of the disease also does not suffer. Delusions and hallucinations form paranoid, paraphrenic syndromes, as well as Kandinsky-Clerambault syndrome. At the onset of the disease, delirium is systemic, but as schizophrenia progresses, it becomes fragmentary and incoherent. Also, as the disease progresses, a syndrome of emotional-volitional disorders appears.

Catatonic schizophrenia

The clinical picture is dominated by disturbances in movement and behavior, which are combined with hallucinations and delusions. If schizophrenia occurs in attacks, then catatonic disorders are combined with oneiroid (special condition, in which a person, based on vivid hallucinations, experiences battles of the titans, intergalactic flights, etc.).

Hebephrenic schizophrenia

The clinical picture is dominated by thinking disorders and emotional disorders syndrome. A person becomes fussy, foolish, mannered, talkative, prone to reasoning, his mood constantly changes. Hallucinations and delusions are rare and absurd.

Simple (mild) schizophrenia

Negative symptoms predominate, and episodes of hallucinations and delusions are relatively rare. Schizophrenia begins with a loss of vital interests, as a result of which a person does not strive for anything, but simply wanders aimlessly and idly. As the disease progresses, activity decreases, apathy develops, emotions are lost, and speech becomes poor. Productivity at work or school decreases to zero. There are very few or no hallucinations and delusions.

Undifferentiated schizophrenia

Undifferentiated schizophrenia is characterized by a combined manifestation of symptoms of paranoid, hebephrenic and catatonic types of the disease.

Residual schizophrenia

Residual schizophrenia is characterized by the presence of slightly pronounced positive syndromes.

Postschizophrenic depression

Post-schizophrenic depression is an episode of illness that occurs after a person has recovered from the disease.

In addition to the above, some doctors additionally distinguish manic schizophrenia.

Manic schizophrenia (manic-depressive psychosis)

The main clinical picture is obsessions and delusions of persecution. Speech becomes verbose and profuse, as a result of which a person can talk for hours about literally everything that surrounds him. Thinking becomes associative, as a result of which unrealistic relationships arise between the objects of speech and analysis. In general, at present there is no manic form of schizophrenia, since it was isolated in separate disease- affective insanity.

Depending on the nature of the course, continuous and paroxysmal-progressive forms of schizophrenia are distinguished. In addition to this, in modern Russia And former USSR also distinguished recurrent and sluggish types of schizophrenia, which in modern classifications correspond to the terms schizoaffective and schizotypal disorder. Let us consider the symptoms of acute (stage of psychosis of paroxysmal-progressive form), continuous and sluggish schizophrenia.

Acute schizophrenia (attacks of schizophrenia) - symptoms

The term acute usually refers to the period of attack (psychosis) of paroxysmal-progressive schizophrenia. In general, as the name implies, this type of schizophrenia is characterized by alternation acute attacks and periods of remission. Moreover, each subsequent attack is more severe than the previous one, and after it there are irreversible consequences in the form of negative symptoms. The severity of symptoms also increases from one attack to another, and the duration of remissions is reduced. In incomplete remission, a person is haunted by anxiety, suspicion, delusional interpretation of any actions of people around him, including relatives and friends, and is also bothered by periodic hallucinations.

An attack of acute schizophrenia can occur in the form of psychosis or oneiroid. Psychosis is characterized by vivid hallucinations and delusions, complete detachment from reality, delusions of persecution, or depressive detachment and self-absorption. Any fluctuations in mood cause changes in the nature of hallucinations and delusions.

Oneiroid is characterized by unlimited and very vivid hallucinations and delusions that concern not only the surrounding world, but also oneself. Thus, a person imagines himself as some other object, for example, pockets, a disc player, a dinosaur, a machine fighting with people, etc. That is, a person experiences complete depersonalization and derealization. At the same time, within the framework of the delusional-illusory idea of ​​oneself as someone or something that has arisen in the head, entire scenes from the life or activity of that with which the person identified himself are played out. The experienced images cause motor activity, which can be excessive or, on the contrary, catatonic.

Continuous schizophrenia

Continuous schizophrenia is characterized by a slow and constant progression of the severity of negative symptoms, which are constantly recorded without periods of remission. As the disease progresses, the brightness and severity of the positive symptoms of schizophrenia decreases, but the negative ones become increasingly stronger.

Sluggish (latent) schizophrenia

This type of course of schizophrenia has many different names, such as mild, non-psychotic, microprocessual, rudimentary, sanatorium, prephase, slow-flowing, hidden, larved, amortized, pseudoneurotic, occult, non-regressive. The disease is not progressive, that is, over time, the severity of symptoms and personality degradation do not increase. The clinical picture of sluggish schizophrenia differs significantly from all other types of disease, since it lacks delusions and hallucinations, but contains neurotic disorders, asthenia, depersonalization and derealization.

Sluggish schizophrenia has the following stages:

• Debut– proceeds unnoticed, as a rule, at puberty;
• Manifest period – characterized by clinical manifestations, the intensity of which never reaches the level of psychosis with delusions and hallucinations;
• Stabilization– complete elimination of manifest symptoms for a long period of time.

The symptoms of the manifest of sluggish schizophrenia can be very variable, since they can occur according to the type of asthenia, obsessive-compulsive neurosis, hysteria, hypochondria, paranoia, etc. However, with any variant of the manifesto of low-grade schizophrenia, a person has one or two of the following defects:
1. Verschreuben- a defect expressed in odd behavior, eccentricities and eccentricity. The person makes uncoordinated, angular movements, similar to a child's, with a very serious expression on his face. General form the person is sloppy, and his clothes are completely awkward, pretentious and ridiculous, for example, shorts and a fur coat, etc. The speech is equipped with unusual turns of phrase and is replete with descriptions of minor minor details and nuances. Productivity of physical and mental activity is preserved, that is, a person can work or study, despite eccentricity.
2. Pseudopsychopathization - a defect expressed in a huge number super valuable ideas with which a person literally gushes. At the same time, the individual is emotionally charged, he is interested in everyone around him, whom he is trying to attract for the implementation of countless extremely valuable ideas. However, the result of such vigorous activity is insignificant or completely absent, therefore the productivity of the individual’s activity is zero.
3. Defect in energy potential reduction – expressed in the passivity of a person who is mostly at home, not wanting to do anything.

Neurosis-like schizophrenia

This type belongs to sluggish schizophrenia with neurosis-like manifestations. A person is bothered by obsessions, but he is not emotionally charged to carry them out, so he has hypochondria. Obsessions last a long time.

Alcoholic schizophrenia - symptoms

Alcoholic schizophrenia does not exist as such, but alcohol abuse can trigger the development of the disease. The state in which people find themselves after long-term use alcohol is called alcoholic psychosis and has nothing to do with schizophrenia. But due to pronounced inappropriate behavior, disorders of thinking and speech, people call this condition alcoholic schizophrenia, since everyone knows the name of this particular disease and its general essence.

Alcoholic psychosis can occur in three ways:

• Delirium (delirium tremens) – occurs after stopping the consumption of alcoholic beverages and is expressed in the fact that a person sees devils, animals, insects and other objects or living beings. In addition, the person does not understand where he is and what is happening to him.
• Hallucinosis- Occurs during heavy drinking. The person is bothered by auditory hallucinations of a threatening or accusing nature.
• Delusional psychosis– occurs with prolonged, regular and fairly moderate consumption of alcohol. It is expressed by delusions of jealousy with persecution, attempts at poisoning, etc.

Symptoms of hebephrenic, paranoid, catatonic and other types of schizophrenia - video

Schizophrenia: causes and predisposing factors, signs, symptoms and manifestations of the disease - video

Causes and symptoms of schizophrenia - video

Signs of schizophrenia (how to recognize the disease, diagnosis of schizophrenia) - video

Post-traumatic syndrome or post-traumatic stress disorder (PTSD) - causes, symptoms, diagnosis, treatment and rehabilitation

• unfavorable forms of schizophrenia, in which the disease, after its onset, proceeds only with progression and leads to the disintegration of personality in a short time (several years)
• a continuous course in which the symptoms of the disease do not stop, there are no temporary lulls.
• paroxysmal course, in which attacks of the disease can be replaced by more or less long periods without painful disorders (remission). Moreover, there are people who have suffered only one attack in their entire lives.
• paroxysmal-progressive course, there is a kind of intermediate type of course, in which increasing personality changes are observed between attacks.

Main forms of schizophrenia

Diagnosis of forms of schizophrenia, even in cases of severe painful disorders in the form of psychoses with seemingly obvious schizophrenic symptoms, requires caution. Not all psychoses with delusions, hallucinations and catatonic symptoms (freezing, agitation) are manifestations of schizophrenia. Below are the most specific psychotic symptoms for schizophrenia (the so-called first-rank symptoms).

Openness of thoughts – the feeling that thoughts can be heard from a distance.
Feeling of alienation is the feeling that thoughts, feelings, intentions and actions come from external sources and do not belong to the patient.

Feeling of influence - the feeling that thoughts, feelings and actions are imposed by some external forces that must be passively obeyed.

Delusional perception is the organization of real perceptions into a special system, often leading to false ideas and conflict with reality.

Differential diagnosis

In cases of acute illness, a doctor can assume schizophrenia based on an examination, conversation with the patient, information from loved ones about how behavioral disorders developed, how the patient behaved. Accurate diagnosis of the form of schizophrenia, especially in cases where the disease is not severe, sometimes requires hospitalization. Modern scientists consider it necessary to monitor the patient for at least a month in order for the diagnosis to be accurate. In these cases, in addition to assessing the history of the disease and the patient’s condition upon admission, the doctor observes the patient’s behavior in the hospital (or day hospital), and also carries out various diagnostic manipulations to exclude other causes of mental disorders.

One of the diagnostically valuable types of examinations is a pathopsychological examination, during which higher mental functions are assessed:

• memory
• attention
• thinking
• intelligence
• emotional sphere
• volitional characteristics
• personal characteristics, etc.

Depending on the manifestations of the disease and its course, several forms of schizophrenia are distinguished:

Paranoid form of schizophrenia

The most common form of the disease. It manifests itself as a relatively stable, usually systematized delusion (persistent false conclusions that cannot be dissuaded), often accompanied by hallucinations, especially auditory ones, as well as other perceptual disturbances. The most common symptoms of paranoid schizophrenia include:

• delusions of persecution, relationship and significance, high origin, special purpose, bodily changes, or jealousy;
• hallucinatory voices of a threatening or commanding nature or auditory hallucinations without verbal expression, such as whistling, humming, laughter, etc.;
• olfactory or taste hallucinations, sexual or other bodily sensations.

Visual hallucinations may also occur.
In the acute stages of paranoid schizophrenia, the behavior of patients is grossly disturbed and is determined by the content of painful experiences. So, for example, with delusions of persecution, the sick person either tries to hide, escape from imaginary pursuers, or attack and try to defend himself. At auditory hallucinations patients of a commanding nature can carry out these “commands”, for example, throw things out of the house, swear, grimace, etc.

Hebephrenic form of schizophrenia

More often, the disease begins in adolescence or young adulthood with a change in character, the appearance of a superficial and mannered passion for philosophy, religion, the occult and other abstract theories. Behavior becomes unpredictable and irresponsible, patients look infantile and foolish (they make ridiculous faces, grimace, giggle), and often strive for isolation. The most common symptoms of hebephrenic schizophrenia include:

• distinct emotional flatness or inadequacy;
• behavior characterized by goofiness, mannerisms, grimaces (often with giggles, smugness, self-absorbed smiles, grand manners);
• distinct thinking disorders in the form of broken speech (violation of logical connections, jumping thoughts, connection of heterogeneous elements not related in meaning);
• hallucinations and delusions may not be present.

For diagnostics hebephrenic form schizophrenia requires observation of the patient for 2-3 months, during which the above-described behavior persists.

Catatonic form of schizophrenia

In this form of the disease, the predominant movement disorders, which can vary in extreme cases from freezing to hyperactivity, or from automatic submission to senseless resistance, the patient’s unmotivated refusal to perform any movement, action or resistance to its implementation with the help of another person.
Episodes of aggressive behavior may occur.

In the catatonic form of schizophrenia, the following symptoms are observed:

• stupor (state of mental and motor retardation, reactions to the environment, spontaneous movements and activity decrease) or mutism (lack of verbal communication of the patient with others while the speech apparatus is intact);
• excitement (purposeless motor activity, not subject to external stimuli);
• freezing (voluntary acceptance and retention of an inadequate or pretentious pose);
• negativism (meaningless resistance or movement in the opposite direction in response to all instructions or attempts to change position or move);
• rigidity (holding a pose in response to an attempt to change it);
• “waxy flexibility” (holding body parts in a given position, even uncomfortable and requiring significant muscle tension);
• automatic obedience;
• getting stuck in the mind of one thought or idea with their monotonous repetition in response to newly asked questions that no longer have anything to do with the original ones.

The above symptoms can be combined with a dream-like state, with vivid scene-like hallucinations (oneiroid). Isolated catatonic symptoms can occur in any other form and other mental disorders. For example, after suffering traumatic brain injuries, in case of poisoning psychoactive substances and etc.

Simple forms of schizophrenia

With this form of schizophrenia, oddities and inappropriate behavior gradually develop, and overall productivity and performance decrease.
Delusions and hallucinations are usually not observed. Vagrancy, absolute inactivity, and aimlessness of existence appear. This form is rare. To diagnose a simple form of schizophrenia, the following criteria are needed:

• the presence of progressive development of the disease;
• the presence of characteristic negative symptoms of schizophrenia (apathy, lack of motivation, loss of desires, complete indifference and inactivity, cessation of communication due to loss of responsiveness, emotional and social isolation) without pronounced delusional, hallucinatory and catatonic manifestations;
• significant changes in behavior, manifested by a pronounced loss of interests, inactivity and autism (immersion in the world of subjective experiences with weakening or loss of contact with the surrounding reality).

Residual (residual) schizophrenia

In this form, after psychotic attacks, the illness persists and continues long time only negative schizophrenic symptoms: decreased volitional, emotional activity, autism.
The patients’ speech is poor and inexpressive, self-care skills, social and labor productivity are lost, interest in married life and communication with loved ones fades, and indifference to relatives and children appears.
Such conditions in psychiatry are usually defined as a schizophrenic defect (or the final state of schizophrenia). Due to the fact that with this form of the disease the ability to work is almost always reduced or lost, and patients often need outside supervision, special commissions determine the disability group for patients.

In the residual form of schizophrenia, the following symptoms are observed:

• distinct negative schizophrenic symptoms, that is, psychomotor slowing, decreased activity, emotional flatness, passivity and lack of initiative; poverty of speech, both in content and quantity; poor facial expressions, eye contact, voice modulation and posture; lack of self-care skills and social productivity;
• the presence in the past of at least one distinct psychotic episode that meets the criteria for schizophrenia;
• the presence of a period, although once a year, in which the intensity and frequency clear symptoms such as delusions and hallucinations would be minimal in the presence of negative schizophrenic symptoms;
• absence of dementia or other brain diseases;
• absence of chronic depression and hospitalization, which could explain the presence of negative disorders.

Criticism of the disease

Criticism of illness - awareness of one’s illness.

IN acute period schizophrenia is usually absent, and very often the initiators of contacting a doctor have to be relatives, close or neighbors of the patient (later, with a decrease in painful symptoms, full or partial criticism may be restored, and the patient becomes, along with the doctor, relatives and friends, an active participant in the treatment process). Therefore, it is very important that those around the sick person take timely measures to ensure that a person who has mental disorders and behavioral disorders is examined by a psychiatrist or psychiatrist-psychotherapist.

In most cases, patients can be persuaded to come to see a doctor for a conversation. There are psychiatrists or psychiatrists and psychotherapists in regional medical centers and in private medical centers. In cases where this does not work, it is necessary to be persistent and try to obtain consent to be examined by a psychiatrist at home (many people who are sick cannot go outside due to painful disorders, so an examination by a doctor at home may be a way out for them).

If the patient refuses this option, you should consult a doctor with the patient’s relatives in order to discuss with the doctor individual management tactics and possible measures for starting treatment and hospitalization. In extreme cases, non-voluntary hospitalization through “psychiatric ambulance" It must be resorted to in cases of threat to the life and health of the patient or his environment.

The specialists of the Brain Clinic provide a complete and accurate diagnosis of the form of schizophrenia. We provide treatment and rehabilitation for all schizophrenia spectrum disorders.

Schizophrenia(literally: “schism, splitting of the mind”) is a complex of mental disorders that have similar signs and symptoms. In schizophrenia, all manifestations of mental activity are affected: thinking, perception and response (affect), emotions, memory. Therefore, the symptoms of schizophrenia are both pronounced and vague, and its diagnosis is difficult. The nature of schizophrenia is still largely mysterious; Only the factors that provoke it and, in the most general terms, the initial mechanism are known. Schizophrenia is the third most important factor causing permanent loss of ability to work and disability. More than 10% of schizophrenics attempt suicide.

Forms

There are four generally recognized forms of schizophrenia. Different psychiatric schools define them differently and classify their varieties, schizophrenic disorders, psychoses, in different ways. In Russian psychiatry the following division is accepted:

1. Simple– without hallucinations, delusions, obsessions. It’s just that the personality gradually disintegrates. It used to be called progressive dementia. Rare, but dangerous form: You can recognize it when things have already gone far.
2. At hebephrenic schizophrenia, thinking and memory are largely or completely preserved, but in emotional and volitional terms the patient may be unbearable for others. An example is the above-mentioned Howard Hughes.
3. Catatonic schizophrenia- alternating periods of frantic, meaningless activity with waxy flexibility and stupor. In the active phase, the patient can be dangerous to himself and others. That is why, at the slightest sign of it, you should immediately consult a doctor. Moreover, the patient may refuse to speak and talking with him is useless.
4. Paranoid schizophrenia- “schizophrenia as it is,” with all the schizophrenic “bouquet”: delusions, hallucinations, obsessions. The most common form. Treatment methods for paranoid type schizophrenia are the most developed. It is for this form that cases of self-healing of patients have been noted. Patients are most often not dangerous, but are easily provoked to violence.

Causes

The cause of schizophrenia can be: heredity, difficult childhood, stress, nervous and organic (physical) diseases that affect the nervous system - syphilis, AIDS. Alcoholism and drug addiction can both cause the disease and be its consequence. Complete cure impossible for schizophrenia; at best, it is possible to return the patient to society. However, there are many cases where patients got rid of the disease on their own.

A person is at risk of developing schizophrenia when he artificially evokes pleasant memories or sensations, either independently or with the help of stimulants, increasing the concentration of the “hormone” in the blood. Have a good mood- dopamine. In fact, dopamine is not a hormone, but a neurotransmitter, a substance that regulates nervous activity. In addition to dopamine, there are other neurotransmitters.

With regular “self-injection” of dopamine, tolerance (resistance) to it develops, and the effect of self-stimulation measures is weakened. An ignorant person increases stimulation, a vicious circle is formed. In the end, the left, “speaking” and right, “remembering” hemispheres of the brain, unable to withstand the overload, lose coordination with each other. This is the beginning of the disease.

The patient begins to hallucinate: he sees visions, hears voices, objects allegedly transform and begin to perform functions unusual for them. But the patient thinks that all this really exists. Gradually, hallucinations increasingly displace reality and replace it. In the end, the patient finds himself in an imaginary world, compared to which Dante’s hell is an amusement park.

Without outside help, the brain eventually gets stuck (without quotes) in the ocean of its own chaos, and catatonia sets in - complete immobility and detachment from everything. But inside the process is still ongoing, sooner or later the brain completely loses control over its container, vital important functions body, and then death. The course of the disease, from hypertrophied imagination under the influence of drugs to the state preceding catatonia, can be traced from a selection of drawings of patients.

Schizophrenia should not be confused with split personality. In schizophrenia, the personality, figuratively speaking, does not split in two, but falls into small fragments that have no independent meaning.

Schizophrenics, contrary to popular belief, are not capable of unprovoked aggression. But, like all mentally ill people, they are easily provoked. If, according to the World Health Organization, about 1% of the world's population is affected by schizophrenia, then among those sentenced to death and life imprisonment the proportion of schizophrenics is 10%.

Provocateurs for a schizophrenic can be both a hostile attitude towards him and inappropriate sensitivity, “lisping.” According to the recollections of patients who overcame the illness, their condition improved when others treated them as ordinary, non-mental patients. And those around them confirm that with such an attitude, the sick gave them much less trouble.

Schizophrenia can occur either smoothly or in attacks. During breaks (remissions) the patient is completely normal. Timely assistance can achieve stable remission in long years or even for the rest of your life.

There is a so-called “anti-psychiatric movement” under the slogan: “There are no abnormal people, there are abnormal circumstances.” The harm from it is difficult to overestimate. By analogy: being undressed in the cold means finding yourself in abnormal circumstances. But pneumonia and frostbite as a result are dangerous diseases that need to be treated so as not to remain crippled or die.

Signs

Schizophrenia most often begins and develops gradually. The riskiest age is almost mature teenagers and not quite mature adults. It is possible to detect the onset of the disease 30 months before its obvious manifestation (prodrome period). The first signs of schizophrenia, in descending order of importance, are:

• A person suddenly freezes in a certain position, and his body acquires waxy flexibility: take his hand, lift it, it will remain that way.
• A person conducts a dialogue with someone imaginary, not paying attention to those who really exist, and if he is brought out of this state by a sharp influence, he cannot explain with whom and what he was talking about.
• Sperrungs appear in the patient’s speech: he discusses something in detail or with enthusiasm, suddenly falls silent mid-sentence, and cannot answer the question: what was he talking about.
• Pointless repetition of actions or the same senseless refusal from them. Examples: a person thoroughly washes a place on his clothing where there once was a stain that had been removed for a long time. In the summer, being dirty and sweaty, he does not take a shower, and the demand to wash causes him obvious fear and disgust.
• Autism: a person is carried away by some activity to the point of complete abandonment, without being able to obtain fundamental knowledge about it and explain what he is doing and why it is needed. Einstein put it this way: “If a scientist cannot explain to a five-year-old child what he does, he is either mad or a charlatan.”
• A person freezes for a long time with a petrified face, looking at some very ordinary object: an iron, a garden bench, and after shaking he cannot explain what he saw there.
• Weakening of affect (combination of perception with response): if such a person is suddenly pricked or pinched, he will not scream or be indignant, but will calmly turn his face around you, looking like a plasticine mask with tin balls on both sides of the bridge of the nose. He shows equal indifference to the fate of both his enemies and people friendly to him.
• Infatuation with meaningless ideas. Let’s say: “Boris Berezovsky is alive, he bought the right to return to Russia from Putin, had plastic surgery and is quietly living out his life somewhere.” Or, showing all the signs of religious zeal, a person cannot explain what “a reed shaken by the wind” means, “there is no prophet in his own country”, “let this cup pass from me” and other evangelical and biblical expressions that have become winged.
• Fatigue, poor coordination of movements. When writing, especially when typing on a computer, the letters in words are often swapped in pairs: “indirect” instead of “indirect”, “schiates” instead of “is considered”. Knowing grammar, he writes (types) without capital letters and punctuation marks.

If any of the first two signs appear once, the patient should be immediately taken to the doctor. If signs 3 and 4 are systematically observed within a month, you need to consult a psychiatrist or clinical psychologist. The same applies if signs 5 and 6 are observed within 3 months. For signs 7-9 – within six months. For signs 3-9, you need to first talk with the patient and start counting the time again. If during a conversation he himself expresses a desire to see a doctor, he must be satisfied without delay.

Note: In many urban subcultures, it is believed that “shiz is cool.” Their representatives often turn out to be skilled malingerers. The real patients are nothing more than a degraded everyday drunkard, a boor and an insolent person - a patient with alcoholism. A conversation with a psychologist will help clarify the situation in this regard and develop a course of action in this particular case.

A schizophrenic, unlike a brazen malingerer, does not try to pretend to be sick, he thinks that this is how it should be. Most often, at the beginning of his illness, he is quite sociable and willingly talks about himself. But do not try, unless you want to harm the patient, to understand the symptoms of schizophrenia on your own; this is impossible without special knowledge and experience. Only a doctor can make the correct diagnosis, prescribe treatment and care that can return the patient to society. This is done according to three groups of symptoms:

Symptoms

Symptoms of the first rank

Symptoms of the first rank: one is enough for a diagnosis, but at home, in one’s own circle, they cannot be recognized due to family, friendship or intimacy. If a child said: “Mom, I know what you’re thinking about,” he may have simply guessed by his facial expression.

• Reading thoughts, exchanging thoughts, openness of thoughts (“And I have no roof at all, and everyone can see everything there”).
• The idea of ​​taking possession of the entire patient or part of his body by someone or something from the outside.
• Imaginary voices coming from outside or from parts of the body.
• Ridiculous, most often grandiose ideas, defended contrary to the obvious. Examples: “Vitya Tsoi is cooler than God, and I’m cooler than Tsoi”; “My father is the President of Ukraine, and I am the President of the Universe.”

Symptoms of the second rank

Symptoms of the second rank also indicate mental disorder, but with one of them it may not be schizophrenia. To be defined as schizophrenia, any two of the following must be present:

• Any persistent hallucinations, but without attempts to respond to them: the patient does not try to fight or wrestle with someone imaginary, go somewhere with him, or enter into an intimate relationship. Psychiatrists simply call it: “Without affect.” Instead of hallucinations, there may be an obsession, for the patient it means more than life, “extra valuable”, but does not aspire to the universe. An example is the “teaching” of Howard Hughes about the three “white poisons” - bread, sugar and salt, because of which outstanding aircraft designer, a businessman and producer, simply starved himself to death.
• Ragged, meaningless speech, inexplicable and unpronounceable normal person neologisms, sperrungs. Here is an example of “poetic creativity” of this kind: “Bizli, tvyzli, vzhdgnuzlye hstvydyzli. Dranp hyldglam untkvirzel vrzhdglam.” The patient claimed that these were spells with which he maintained contact with another reality. According to the recollections of the attending physician, he could spend hours pouring out such combinations of sounds as peas.
• Catatonia, waxy flexibility, stupor.
• Autism.

Negative symptoms indicate the absence or weakening of something: willpower (apathy), the ability to sympathize and empathize (flattening of affect), self-isolation from society (sociopathy). Based on an analysis of the symptoms of each group, the doctor, using psychiatric classifiers (of which there are several, and they differ significantly from each other), and from his own experience, recognizes the form of schizophrenia and prescribes treatment.

Treatment

Currently, schizophrenia is treated with antipsychotics - medications that affect the circulation of neurotransmitters in the body. Antipsychotics are either atypical (the first to be discovered) or typical. Atypical ones regulate (suppress) the general exchange of mediators. They act more powerfully and are cheaper, but they cause lasting consequences (loss of potency and weakening of mental abilities), and even a severe, even fatal, reaction of the body. Typical antipsychotics are much more expensive, but act selectively and more gently. Treatment with them until stable remission takes a long time and is expensive, but the patient returns to society sooner.

In especially severe cases, treatment of schizophrenia is carried out using shock therapy methods: artificially inducing convulsions, using electric shock. The goal is to “de-cycle” the brain so that further treatment can be carried out in collaboration with the patient. These methods are cruel, but sometimes necessary. There are known cases when catatonic patients in psychiatric hospitals suddenly jumped up during a fire or bombing and subsequently behaved like normal people.

Brain operations, such as those described by Robert Penn Warren in the novel “All the King's Men,” are now almost never used. The goal of modern psychiatry is not to protect others from the patient, but to return him to society.

The greatest difficulties in the treatment of schizophrenia are created by stigmatism and “branding”. Everyone shuns the “schizo”, insults him, and mocks him. Instead of positive emotions that reduce excess dopamine, the patient receives negative ones that require an additional “injection” of it, and the disease worsens.

Is it possible to overcome schizophrenia?

Yes, you can. At paranoid schizophrenia sick for a long time is able to distinguish hallucinations from reality, but they do not bother him, they seem to him like something funny, pleasant, a manifestation of some kind of superpower. Let's remember - dopamine works in the body.

But, having found some clue, you can “filter” hallucinations from reality and be completely cured. If the disease is noticed in the first stages, this can be done even unnoticed by others. In general, the sick you are, the better you are treated. World famous examples - John Forbes Nash, American mathematician, Nobel laureate in economics, the hero of the book and film “Beautiful Mind” and the Norwegian psychologist Arnhild Lauveng, independently, after several hospitalizations, achieved complete stable remission.

Sincerely,