What is schizophrenia disease? Causes, symptoms, diagnosis and treatment of schizophrenia. Mental illness schizophrenia: signs, symptoms and treatment

Schizophrenia, according to statistics, is one of the most common causes of disability in the world. Schizophrenia itself, the symptoms of which are characterized by severe disturbances in thought processes and emotional reactions, is a mental illness, the majority of which has been observed since adolescence.

general description

As we indicated above, schizophrenia mainly manifests itself in adolescence, its manifestations are somewhat less common after the age of twenty, and, finally, the development of schizophrenia after the age of fifty is extremely rare.

Until the end, the reasons that provoke the development of the disease in question have not been clarified. However, most experts agree that heredity is the main predisposing factor for the development of schizophrenia. In addition, the relationship with such types of factors as alcoholism, emotional disorders, certain injuries, drug addiction, social problems is not excluded.

Incidence rates for the whole world indicate a prevalence of schizophrenia of about 1%, which, by the way, is quite a lot. It is noteworthy that women are more prone to recovery than men.

Important points in this are the characteristics of the character of the patient, as well as the presence of emotional support received from loved ones. Given the significance of the loads that are directed not only to the nervous system in schizophrenia, but also to the cardiovascular system and a number of their other varieties in the body, it can be seen that the total life expectancy for patients with this diagnosis is slightly lower than for people without it.

Meanwhile, there is also a special “margin of safety”, which determines the ability to withstand significant physical exertion and stress (resistance to hypothermia, slight susceptibility to SARS and other types of viral diseases).

By the way, it has been determined that future schizophrenics, as a rule, are born during the junction of the seasons of winter and spring (that is, during March-April). This can be explained, for example, by the vulnerability of biorhythms or the impact on the mother of certain infections during pregnancy.

Schizophrenia: classification

Schizophrenia can proceed continuously (with an increase and increase in symptoms in a steady form, without remission) or paroxysmal (respectively, with periods of remission). In the latter case, it is precisely due to the appearance of remissions that paroxysmal schizophrenia resembles manic-depressive psychosis.

Continuous schizophrenia , in turn, can manifest itself in the following forms:

• Malignant schizophrenia (or hebephrenia). It mostly manifests itself during adolescence. The regression of behavior, inactivity and emotional dullness acquires relevance. In childhood, the course of this type of schizophrenia is accompanied by inhibition in mental development, a decrease in academic performance. Due to the severity of the manifestations of the disease, patients often have to complete schooling with healthy children.
• Sluggish schizophrenia (maloprogressive schizophrenia). It manifests itself mainly in adolescence, the development of the disease lasts for many years, the personality changes relevant to the disease increase gradually. The prevailing character is acquired by neurosis-like and psychopathic disorders.

Flow paroxysmal schizophrenia available in the following options:

• Schizophrenia is paroxysmal-progredient. In particular, it combines a continuous flow with a paroxysmal flow. Accordingly, the disease in this form can manifest itself only in the form of a single attack, which, in turn, is followed by a long remission. Meanwhile, the manifestations of the following attacks are more severe. Each of the attacks is characterized by its acute variability, due to which there is a rapid change in the general condition of the patient.
• Schizophrenia is periodic (or recurrent schizophrenia). The disease in this form is characterized by the duration and severity of attacks of its manifestation. Basically, these manifestations act as schizoaffective psychoses. There are also periods of prolonged and deep remission between attacks. Directly during seizures, patients have a complete violation of the perception of everything that surrounds them. This variant of the course of schizophrenia can be observed in any age category.

Causes of schizophrenia

As we have already noted, the causes of the development of schizophrenia have not yet been fully elucidated, however, despite this, there are a number of assumptions regarding the influence of specific types of factors contributing to the emergence of this disease.

• Heredity. Based on statistical data, it is known that among people whose relatives were sick with schizophrenia, this disease is noted in 10% of cases. Predominantly genetic predisposition to schizophrenia is relevant for identical twins. So, if one of them has schizophrenia, then the risk of developing this disease for the second twin increases to 65%. Meanwhile, there is an opinion that only one genetic risk for the development of the disease is not enough, respectively, only on the basis of such a situation as predisposing to the disease, it, meanwhile, can be excluded.
• Violations associated with the course of intrauterine development processes. As a result of exposure to certain infections, the risk of the fetus subsequently developing this diagnosis is not excluded.
• Education in childhood. This reason for the most part is only a hypothesis, and it lies, according to some psychoanalysts, in the development of schizophrenia in those patients who were given little attention by their parents in childhood.
• Factors of social scale. These include various types of stressful situations provoked by social status, which is directly associated with poverty and unemployment, with frequent conflicts with the environment and with moving. In addition, a number of researchers insist that loneliness can also be considered a risk factor that provokes the development of schizophrenia.
• Having bad habits. At the moment there is no exact statement of the connection between alcoholism and drug addiction and schizophrenia, however, if we talk about amphetamines, then their effect significantly exacerbates the symptoms of schizophrenia. Accordingly, stimulating and hallucinogenic drugs (including alcohol) can also provoke the development of this disease.
• Violations associated with the activity of chemical processes in the brain. This theory indicates the development of the disease under consideration against the background of an imbalance in the processes of brain activity with the participation of neurotransmitters (substances that ensure the transmission of nerve impulses to the tissues). According to some scientists, the development of such an imbalance is possible even in the process of intrauterine development, but its direct manifestations are noted after the puberty of patients.

Schizophrenia: symptoms

The initial stages of the disease we are considering, as a rule, are accompanied by a weak severity of symptoms, or even its absence. Often, the manifestations of schizophrenia at this stage can be confused with the symptoms of another type of disease, or they are generally excluded from attention due to their relative insignificance. It is this feature of the onset of this disease that is its main danger, because it is better to start treatment precisely at the onset of symptoms, where it is possible to achieve an effective result. Subsequently, the symptoms of schizophrenia can be very diverse in manifestations, but we will highlight those that act as the basis of the foundations.

Schizophrenia in adults: symptoms

Symptoms in this case can be divided into the following groups:

• positive symptoms. These include symptoms in the form of delirium, "voices in the head", the pronunciation of words that do not have a semantic load, as well as the feeling of patients being observed, supposedly carried out behind them from the outside.
• negative symptoms. Withdrawal from social life and events, lack of emotional manifestations, intentional self-isolation, inability to enjoy anything, unwillingness to take care of oneself properly.
• cognitive symptoms. Actual disorders of memory and thinking, the emergence of difficulties in trying to process even the most, at first glance, primitive information.
• Mood symptoms. These include sudden mood swings, depression.

Separately, you can determine the symptoms of schizophrenia in men:

Social self-isolation;

Aggressiveness;

Persecution mania;

Symptoms of schizophrenia in women also have their own characteristics of manifestations:

Persecution mania;

Frequent reflection;

hallucinations;

Conflicts based on social interests.

It is noteworthy that, in general, the symptoms of schizophrenia in both sexes are practically the same, while the features of the manifestation of these symptoms may differ: in women, they often appear in the form of attacks, while in men, the manifestations of symptoms are continuous. In addition, one can single out such a feature that male schizophrenia has as an increased addiction to alcohol. Also, again, for men, statistics indicate that their disease begins at an earlier age (approximately from the age of 15), while the first symptoms of schizophrenia in women are noted somewhat later - after twenty years.

Schizophrenia in children: symptoms

Among the main symptoms inherent in the manifestation of schizophrenia in children, the following can be distinguished:

• irritability;
• rave;
• hallucinations;
• motor spectrum disorders;
• aggressiveness.

Quite often, the listed symptoms are attributed by parents to the wild imagination of their child and, in general, to the features of their development. Establishing an accurate diagnosis is possible only when contacting a specialist, which, based on the previously noted factor, is extremely rare. Meanwhile, a specialist can determine schizophrenia in a child already from his age of two years.

Schizophrenia in adolescence: symptoms

The main manifestations in this case are as follows:

• isolation;
• academic failure;
• aggressiveness.

Severe forms of schizophrenia are accompanied by severe dementia.

Diagnosis of schizophrenia

Diagnosis of the disease is complex, it is based on a number of the following methods:

• conducting an initial survey of the patient, a detailed survey of him (including taking into account bad habits and an adequate assessment by relatives, also made during the conversation);
• use of psychological tests;
• sleep monitoring (at night);
• conducting a virological study;
• conducting a neurophysiological study;
• scanning of cerebral vessels;
• electroencephalography;
• lab tests.

Treatment of schizophrenia

Before proceeding to a brief review of the methods used in the treatment of schizophrenia, we note that today in medicine there are no such methods that could completely cure this disease. Through the use of a number of methods, relapses can be completely excluded, although, again, the possibility of their subsequent repetition is not excluded.

Among the methods used to treat schizophrenia, we highlight the following:

• drug therapy;
• electroconvulsive therapy (used when drug therapy is ineffective, involves the passage of electrical impulses through the brain);
• insulin coma therapy (implies the introduction of significant doses of insulin to cause glycemic coma, is used very rarely);
• surgical intervention (used in the conditions of modern medicine is extremely rare and only in exceptionally extreme cases in the absence of results from the use of other methods);
• social therapy (implies the improvement of the patient's living conditions, the long-term implementation of such measures ensures appropriate effectiveness);
• psychotherapy (used as a supportive method of treatment, for example, in combination with drug therapy, helps to alleviate the general condition of the patient).

Schizophrenia is diagnosed by a psychiatrist.

Is everything correct in the article from a medical point of view?

Answer only if you have proven medical knowledge

- This is a disease of endogenous origin (due to internal changes occurring in the body), characterized by a paroxysmal or continuous course, manifested in a person's personality changes and accompanied by multiple productive symptoms. The fundamental difference between this disease and other mental disorders is that schizophrenia occurs on its own and is not associated with external factors. In medicine, you can find synonyms for the name of this disease - Bleuler's disease, discordant, dementia praecox. Due to the variety of symptoms, doctors often talk about this disease in the plural, that is, about discordant psychoses.

Schizophrenia is quite widespread. So, out of 1000 people, from 4 to 6 individuals will be affected by this disease, which is 0.4-0.6%. Gender in this case does not matter, but in men, schizophrenia manifests itself at an earlier age. For the first time, the disease manifests itself quite early, usually between 15 and 30 years. As practice shows, every tenth sick person decides to commit suicide.

In the mass consciousness, the understanding has strengthened that a schizophrenic is a mentally retarded or feeble-minded person. However, the level of intelligence of such people can be different: low, medium, high, and even very high. History knows many great personalities who suffered from schizophrenia, including world chess champion B. Fischer, Nobel Prize winner mathematician D. Nash, famous Russian writer N. Gogol and others.

Therefore, do not take this psychosis as an abnormality. Schizophrenia, in fact, is a special disorder of such mental processes as perception and thinking. A sick person with normally functioning memory and intellect has a brain that adequately perceives information. However, the cerebral cortex is not able to process these data correctly.

To understand how a patient with schizophrenia sees the world around him, you can turn to an example. Seeing green grass, a healthy brain will transmit this information to the cortex, where it will be processed. The result will be the following: this is a natural process for nature, which means a warm season. The output of the consciousness of a patient with schizophrenia will be somewhat different, although he will also see green grass. But he may think that someone painted it, that it is the creation of the hands of foreign beings, that it needs to be destroyed, etc. This is a distorted picture of the world, which is formed against the background of an incorrectly working consciousness. That is why, translated into Russian, the term "schizophrenia" in the final interpretation sounds like "split consciousness".

Signs and symptoms of schizophrenia

It is worth distinguishing between two concepts - signs and symptoms of the disease, since they will differ in the context of this mental disorder. Signs are understood as only 4 areas of brain activity that have disorders. They are also called Bleuler's tetrad. As for the symptoms, they are specific manifestations that characterize schizophrenia.

So, the signs of the disease are:

Associative defect or alogia. It is characterized by a lack of logical thinking, the inability of the patient to complete any dialogue or reasoning. Alogia is explained by the scarcity of the speech reserve, the absence of additional components in the speech. This is expressed in the parsimony of the dialogue, in concrete, monosyllabic answers to questions that all the time require clarification. The patient is not able to think out the logical chain of the discussion. For example, a dialogue between two familiar healthy people looks like this: “Where are you going?”, To which the answer will be given: “To mother, it’s her birthday.” The answer of the schizophrenic will be the following: “To the mother”, which requires additional clarification from the interlocutor: “For what?”. The new answer will also be monotonous: “Congratulations,” which again requires clarification of details: “Does she have any holiday?”. “Holiday,” a person with a mental disorder will answer. “Which one?” - the interlocutor will have to find out again, etc. That is, the patient’s thinking is not able to extend, build a logical chain of dialogue, since the patient does not foresee possible questions that seem to a healthy person to be a completely natural continuation of the conversation.

Autism. This sign is characterized by the distancing of a person from everything around, immersion in himself, in the world he created by himself. The interests of the patient are limited, the actions are monotonous, it is difficult for him to evoke a response. A person cannot build normal communication with the people around him. The patient completely lacks a sense of humor, he perceives all phrases literally. Such people think stereotypically, stereotyped.

affective inadequacy. This sign is characterized by an absolutely inadequate reaction to the events taking place around. So, at a funeral, the patient can laugh uncontrollably, and during the general fun at the birthday party, start sobbing. However, at the same time, external expressions of feelings do not correspond to internal experiences. That is, the patient experiences the strongest or fear, but at the same time laughs hysterically.

Ambivalence. This sign is manifested in the fact that a person simultaneously experiences absolutely contradictory feelings in relation to the same object. For example, a patient both loves and hates pasta, swimming, etc. It is worth distinguishing between emotional (contradictory feelings in relation to other people, events, objects), volitional (endless hesitation when it is necessary to make a specific choice) and intellectual (contradictory ideas that mutually exclusive) ambivalence. The combination of these signs becomes the reason that the patient withdraws into himself, loses interest in the world around him, and behaves ridiculously. Personality disorders are manifested in the emergence of new hobbies, for example, in a craving for philosophical reflection, for religious teachings, for a fanatical passion for a certain idea. Gradually, a person completely loses his ability to work, becomes asocial.

Positive symptoms of schizophrenia. In this case, the term "positive" does not carry the meaning of "good". It in the context of schizophrenia means that the patient begins to show those symptoms that he had not observed before.

Positive symptoms of schizophrenia are characterized by the following features:



• Hallucinations, which, in turn, are divided into sound, auditory, olfactory, visual, tactile and gustatory. Most often, patients with schizophrenia suffer from auditory perception disorders, when the patient hears some voices, and his own thoughts seem alien to him. Visual images occur much less frequently; when they appear, they are combined with other types of hallucinations. At the same time, the person himself does not perceive them as a fruit of his own imagination and treats them with complete seriousness;

  Illusions, when the patient sees the real object incorrectly. That is, looking at the table, a person sees a chair, looking at a shadow, sees a living object, etc. At the same time, illusions and hallucinations are different symptoms;

  Nonsense, which represents certain thoughts, conclusions, ideas, but they are absolutely divorced from the surrounding reality. Delusions may occur on their own, or may be the result of hallucinations. Variants of delirium can be very diverse. Most often, a schizophrenic suffers from delusions of persecution, when it seems to him that he is being constantly watched. In addition, there are delusions of influence (hypnosis, harmful rays, etc.), pathological jealousy, self-accusation, hypochondriacal (belief that one has a disease) and dysmorphophobic (belief that one has some kind of disadvantage);

  Inappropriate behavior when a person behaves inappropriately for a particular situation. At the same time, the patient can be depersonalized when it seems to him that his body parts do not belong to him, his relatives are not his relatives, etc. Derealization also occurs when details insignificant for a healthy person are hyperbolized, which makes their perception distorted, unreal ;

  Separately, it is worth highlighting the strongest manifestation of inappropriate behavior- catatonia. The patient at the same time begins to make erratic movements, freezes in unnatural and awkward poses for a long time. It is very difficult to get him out of such a stupor, as the person trying to help runs into resistance. Moreover, the muscle strength of schizophrenics is quite large. As mental excitement grows, such people begin to dance, jump, move quickly and perform other meaningless actions;

  Another striking symptom of inappropriate behavior is hebephrenia., which manifests itself in excessive gaiety, laughter, laughter. At the same time, the situation may not at all tune in a cheerful mood;

  Disorders of thinking and speech. Often this is expressed in long, incoherent and fruitless reasoning. Moreover, it is not important for the patient himself whether the interlocutor understands his monologue, the process of philosophizing itself is important. Such people pay great attention to trifles, slip from one reasoning to another. In the most severe cases, schizophasia is observed, which is characterized by absolutely incoherent speech, since the patient's thoughts are expressed in the form of an uncontrolled stream of words;

  intrusive ideas, which constantly arise in the mind of a schizophrenic patient against his will. A person may be preoccupied with the meaning of life, climate warming and other global thoughts. He is very worried about this, and he cannot stop thinking about this topic.

Negative symptoms of schizophrenia. These symptoms represent qualities lost by a person. They were present until the manifestation of the disease, and then gradually began to fade away. Negative symptoms are manifested in the loss of physical activity, limited range of interests, lack of initiative, etc.

The negative symptoms of schizophrenia are characterized by the following features:



• Difficulties in finding the right solution to any problem;

  Frequent mood swings;

  Disorganized symptoms. They echo positive symptoms, representing their special variety. They are expressed in confused, disorderly speech, in chaotic behavior and thinking.

  Typical syndromes inherent in all patients. They are made up of several positive or negative symptoms. There are certain combinations that are most often found in such patients.

The first signs of schizophrenia

The disease progresses gradually, at first several symptoms appear, which subsequently tend to increase. Then they are supplemented by other manifestations.

The development of schizophrenia can be suspected by the following indicators, which are called symptoms of the first group:

Inability to perform usual activities because the patient does not see any obvious meaning in them. For example, he does not wash his hair, as the hair will get dirty again;

Speech disorders which are expressed mainly in monosyllabic answers to the questions posed. If the patient is nevertheless forced to give a detailed answer, he will speak slowly;

Low emotional component. The patient's face is inexpressive, it is impossible to understand his thoughts, he avoids meeting his eyes with the interlocutor;

Low concentration on any subject or object of action;

Anhedonia is also an early sign of the disease. At the same time, even activities that previously attracted a person, gave him moments of joy, now become completely uninteresting.

In the primordial stage of schizophrenia, the patient becomes more suspicious, slightly bizarre. Close people note a weak emotional inadequacy so far. In the future, all symptoms will gradually increase.

Causes of schizophrenia

There are several theories for the development of this disease. The approaches are quite diverse, among the most well-known hypotheses of the origin of schizophrenia are the following:

neurotransmitter theory. The dopamine concept boils down to the fact that the disease begins to develop due to an increase in the concentration of the hormone dopamine in the body. It stimulates neurons, which begin to produce more impulses, which causes disruption of the brain. Based on this theory, patients are treated with drugs that block receptors responsible for the production of dopamine;

Serotonin theory It is based on the fact that serotonin receptors work excessively actively, which leads to increased production of this hormone and insufficient transmission of the nerve impulse. Therefore, some new antipsychotics contain substances that affect the production of serotonin;

Noradrenergic theory indicates the involvement in the development of the disease of the hormones adrenaline, dopamine and norepinephrine, for the production of which the noradrenergic system is responsible;

Dysontogenetic theory. It is based on the fact that a person initially has structural anomalies in the structure of the brain. As a result of a number of factors, decompensation of these structures occurs, which causes the development of schizophrenia. Toxic substances, viruses, bacteria, genetic disorders become detrimental to the brain. Adherents of this theory do not exclude the presence of people at risk, which brings the dysontogenetic hypothesis closer to hereditary;

psychoanalytic theory. According to this hypothesis, the disease begins to develop against the background of a split personality. At the same time, internal self-awareness, the predominance of one's own "I" begins to prevail over external circumstances, suppressing them. When the surrounding reality is perceived by the patient as a threat to his existence, he seeks to withdraw into himself. Misunderstanding of society in this case causes further alienation;

The theory of predisposition (constitutional and hereditary). The fact that the disease can be transmitted from parents to children is evidenced by many facts, among which statistics play an important role. So, when one parent is sick, the child runs the risk of schizophrenia in 12% of cases, and when both parents are sick, the risk increases to 40%. In addition, in identical twins, the disease will show the same signs by 85%, and in fraternal twins by 20%. However, scientists have not yet been able to find the gene for schizophrenia. However, certain chromosomal combinations have been identified that prevail in all patients;

constitutional theory suggests that a particular organism has specific characteristics. For example, this is the ability to respond to stress factors, the nature of a person, and body features. Also, adherents of this hypothesis put forward their own concept of "schizoid temperament". Such a person is characterized by certain features: suspicion, rejection of the outside world, etc.;

Theory of autointoxication and autoimmunization. Scientists who adhere to this hypothesis argue that the disease is caused by the poisoning of the body by the products of protein metabolism that have not undergone complete cleavage. Among the substances that pose a threat, they emit ammonia, phenolcresols and others. In addition, an additional negative factor is the periodic oxygen starvation of the brain, against which the processes occurring in it are aggravated;

Stages of schizophrenia

The disease slowly passes through several stages of development. There are four of them:

primordial stage, on which the basic personal characteristics of the patient begin to change. The person becomes more suspicious, his behavior changes, becomes somewhat inadequate.

prodromal stage. The patient tries to isolate himself from the world, is protected from contacts with parents, friends, loved ones. The person becomes more distracted, uncollected, experiences difficulties at work and in the performance of household chores.

Stage of the first psychotic episode. At this time, hallucinations occur, delirium appears, the patient begins to pursue obsessive ideas.

remission stage. A person completely disappears all the symptoms of schizophrenia. This time period can be either long or short. After a temporary remission, the patient again has an exacerbation stage.

Types and forms of schizophrenia

It is customary to distinguish seven types of the disease, each of which is characterized by a specific clinical picture:

hebephrenic;

paranoid;

catatonic;

undifferentiated;

residual;

• Post-schizophrenic depression.

Forms of schizophrenia are distinguished based on how the disease progresses:

Continuously flowing;

recurrent;

Paroxysmal-progredient;

Sluggish;

Febrile (accompanying an increase in body temperature);

Protracted pubertal schizophrenia;

paranoid schizophrenia

This type of illness is characterized by undisturbed thought processes, the patient mainly suffers from delusions and hallucinations. It is paranoid delusions that predominate, delusions of grandeur, persecution or influence prevail. Emotional disorders are not very pronounced, sometimes absent altogether.

Sluggish schizophrenia

There are many names for this type of disease, for example, sluggish schizophrenia is often called non-psychotic, mild, sanatorium, etc. The symptomatology of this type of disease is different in that personality disorders and an increase in the clinical picture do not occur over time. The patient is not delirious, does not suffer from hallucinations. Among the main symptoms of the latent form of the disease: asthenia, derealization, depersonalization and neurotic disorders. After an inconspicuous debut, it is replaced by a manifest period with more vivid symptoms of the disease, which, in turn, is replaced by a stabilization of the state on a long period time.

Manic schizophrenia

The patient suffers from obsessions and delusions, among which persecution mania prevails. For hours, a person talks in verbal form about being surrounded by enemies, being followed, etc. In modern medicine, they no longer talk about manic schizophrenia, since it was decided to separate it into a separate form of mental disorder - into manic-depressive psychosis.

Hebephrenic schizophrenia

The patient has disorders of thought processes and emotional disturbances. Such people are characterized by frequent and abrupt mood swings, they are frivolous, fussing needlessly, and talk a lot. Delusions and hallucinations are most often absent.

Hidden schizophrenia

The illness is mild. Her debut, which usually falls on adolescence, goes unnoticed by others. The clinic is diverse, but dimly expressed. Patients are asthenic, sometimes fall into hysterics, may suffer from paranoia or hypochondria.

However, it is possible to determine that a person has latent schizophrenia by the fact that he will always have at least one of these three signs:

Oddities of behavior, awkward clothes, angular movements, sloppy appearance, descriptive speech with turns unusual for a healthy person (Verschroben);

The presence of very important ideological thoughts, which he constantly shares with others, tries to implement them, is always on an emotional upsurge, but not a single idea gives a productive result (pseudo-psychopathization);

The patient is passive, constantly wants to stay within the house, there is no desire to do anything (dynamic devastation).

hereditary schizophrenia

As for the possibility of transmission of the disease by inheritance, most doctors are of the opinion that this is quite real. If there was no relative with a similar disease in the immediate environment, then the risk of a person developing schizophrenia does not exceed 1%. As for the line of transmission, no such pattern was identified, the risks are equally preserved for both men and women.

Diagnosis of schizophrenia

To make a diagnosis, a psychiatrist will need at least six months to observe the alleged patient. The clinical manifestations of the disease are recorded, they are compared with the criteria developed by the UN and the American Psychiatric Association.

So, according to the ICD, the patient must have at least 2 signs from the criteria of the first rank:

Crazy idea;

Hallucinations (auditory);

The sound of thoughts.

In addition, a person must meet the criteria of the 2nd rank:

Weak hallucinations, constantly pursuing the patient;

A break in thoughts, which is clearly seen in speech;

Signs of catatonia;

Several negative symptoms;

Disorders in the behavioral sphere.

In addition to the previous diagnostic methods, there are evaluation criteria forDSM-V. They suggest the presence of 2 or more symptoms in a patient (manifested for 30 days or more):

hallucinations;

catatonia;

negative symptoms;

Disorders of thinking and speech.

It is important to differentiate schizophrenia from other neurological disorders. This allows you to make additional tests and techniques, as well as careful monitoring of the patient.

How to treat schizophrenia?

The main goal of the therapeutic effect is to establish a stable remission, the maximum delay in the onset of negative symptoms. During the period of exacerbation, the patient must be hospitalized so that he can receive adequate and timely assistance. This will reduce the risk of developing psychosis and reduce its possible complications.

When the acute period is over, the person can be taken away by relatives and friends. They help a person go through the rehabilitation stage, which helps prevent the early development of the last stage of the disease. To do this, there are various cognitive training, occupational therapy. The socialization of the patient is necessary, relatives of a person with schizophrenia should receive maximum information on how to properly organize the patient's life.

Naturally, for the full treatment of the disease, medication is necessary. Antipsychotic agents are used, which have a diverse composition and have a wide spectrum of action.

Classic antipsychotics or, as they are called, typical, act mainly on dopamine receptors, blocking their work. Among such funds are Aminazine, Tizercin, Haloperidol.

Atypical neuroleptics belong to the new generation of drugs. They also affect dopamine receptors, but in addition to this, they affect the work of adrenaline, serotonin and other receptors. Among these drugs can be noted Clozapine, Amisulpride, Olanzapine, etc.

Partial agonists, such as Aripiprazole and Ziprasidone, represent a class of newer drugs. They simultaneously block and activate dopamine receptors, depending on the level of dopamine.

15 most effective drugs for schizophrenia

Any drug aimed at the treatment of schizophrenia cannot be prescribed without medical advice. Only a doctor has the right to prescribe tablets, and it is extremely important to familiarize yourself with the contraindications for each drug.

The 15 most effective drugs for schizophrenia that were identified in a survey of relatives of sick people:

Clopixol Depot.

Moditen Depot.

Azaleptin.

Amitriptyline.

Haloperidol.

Haloperidol Decanoate.

Zyprexa.

Zyprexa Zidis.

Carbamazepine.

1. Triftazin.

   Fluanxol.

   Chlorprothixene.

   Cyclodol.

Education: In 2005, she completed an internship at the First Moscow State Medical University named after I.M. Sechenov and received a diploma in Neurology. In 2009, she completed her postgraduate studies in the specialty "Nervous Diseases".

One of the most complex and little-studied diseases that affects the human psyche, his speech, thinking and behavior is schizophrenia. To date, the nature of this disease, the causes of its development and complete symptoms have not been fully studied. It is impossible to get rid of the disease - it is chronic, but with proper and timely treatment, attacks can be stopped, their frequency and regularity reduced, which will help a person lead a more or less normal life. Recently, the disease is becoming more common and every year more and more people are registered with this diagnosis. Men and women are equally affected, but schizophrenia affects, as a rule, the younger generation aged 15-28 years.

What is schizophrenia?

Schizophrenia is a chronic, gradually increasing changes in the psyche, human behavior, speech and motivation. For many decades, this disease has been studied, but even today it remains a mystery and many points are not clear to physicians and scientists (for example, the causes of development, factors provoking seizures, and more).

In the people, this disease has received its name "split personality". This is caused by a significant change in behavior, illogical thinking during the development of the disease, which is significantly different from the classical course of thought of a person in his right mind.
There are several stages of the disease:

Reasons for the development of the disease

To date, scientists cannot name reliable causes of the development of the disease, since it is not fully understood. Many hypotheses are put forward, but none of them has found scientific and practical confirmation. In the course of work and research, it was possible to establish factors that can provoke the onset of psychopathological processes. These include:

Signs of schizophrenia

The disease is manifested by mental disorders, changes in behavior and illogical thinking. The main symptoms of schizophrenia include:

Diagnosis of the disease

In order to prevent the active progression of the disease, it should be detected in a timely manner and appropriate measures for its treatment should be taken. For the diagnosis of schizophrenia, you should seek the advice of. Before making a diagnosis, the doctor conducts a series of studies:

• Visual examination of the patient.
• A conversation with the patient, during which the doctor evaluates the adequacy of behavior, the logic of thinking, reveals pathological deviations in the psyche.
• Collecting a family history, identifying relatives who have mental disorders. Sometimes this is not as easy as it seems at first glance, since many people with disabilities do not seek professional help, are not registered in psychiatric clinics, which greatly complicates the process of diagnosis.
• Establishment of objective factors that could provoke the disease: injuries, diseases, stress.
• Testing for schizophrenia.

A psychiatrist can make a diagnosis of schizophrenia only with a minimum duration of the disease - 6 months, since with a shorter course it can simply be acute mental disorders that can be treated and pass in a short time. If necessary, the patient is admitted to a psychiatric hospital, where a more thorough examination and emergency therapy are carried out.

Treatment of schizophrenia

Alas, there is no effective method of treating the disease today, but there are a number of medicines and techniques that can reduce the manifestation of symptoms and slow down the progression of the disease. It is extremely important that all medicines are prescribed by a specialist after a complete examination of the patient and diagnosis. The main goal of treatment is to achieve a long and stable remission.
The following factors influence the choice of therapy:

• stage of development of the disease.
• The frequency and regularity of the occurrence of seizures.
• Clinical picture of the course of the disease.
• The general health of the patient.
• The presence of other diseases (physiological or mental).

The effectiveness of treatment depends on the right therapy, with the right choice of medicines, a person can live a full life: go to work, start a family and lead a normal life. In the acute form of the course of the disease, the patient is placed in a hospital, this is done so that doctors can monitor the patient's behavior, evaluate the effectiveness of the prescribed treatment and timely identify adverse reactions to medications.
Treatment for schizophrenia includes:

Prevention of schizophrenia

It is impossible to prevent the disease, since the exact cause of its development has not been established. The only thing that can be done to relieve symptoms is to promptly seek help from specialists when alarming symptoms appear and follow all the recommendations that will help to significantly prolong and strengthen remission.

Schizophrenia... For many, if not all people, this disease sounds like a stigma. "Schizophrenic" is a synonym for the finale, the end of existence and uselessness for society. Is it so? Alas, with such an attitude, it will be so. Everything unfamiliar is frightening and perceived as hostile. And a patient suffering from schizophrenia, by definition, becomes an enemy of society (I want to note, unfortunately, it is our society that is not the case in the whole civilized world), because others are afraid and do not understand what kind of "Martian" is nearby. Or, even worse, they mock and mock the unfortunate. Meanwhile, you should not perceive such a patient as an insensitive deck, he feels everything, and very sharply, believe me, and first of all, his attitude towards himself. I hope to interest you and show understanding, and therefore sympathy. In addition, I want to note that among such patients there are many creative (and well-known) personalities, scientists (the presence of a disease does not detract from their merits) and just sometimes people who are close to you.

Let's try together to understand the concepts and definitions of schizophrenia, the features of the course of its symptoms and syndromes, and its possible outcomes. So:

From Greek. Schizis - splitting, phrenus - diaphragm (it was believed that this was where the soul was).
Schizophrenia is the "queen of psychiatry". Today, 45 million people suffer from it, regardless of race, nation and culture, 1% of the world's population suffers from it. To date, there is no clear definition and description of the causes of schizophrenia. The term "schizophrenia" was introduced in 1911 by Erwin Bleuiler. Prior to that, the term "premature dementia" was in use.

In domestic psychiatry, schizophrenia is "a chronic endogenous disease, manifested by various negative and positive symptoms, and characterized by specific progressive personality changes."

Here, apparently, we should pause and take a closer look at the elements of the definition. From the definition, we can conclude that the disease proceeds for a long time and carries a certain staging and regularity in the change of symptoms and syndromes. Wherein negative symptoms- this is the "falling out" from the spectrum of mental activity of pre-existing signs characteristic of this person - flattening of emotional response, reduction of energy potential (but more on that later). The positive symptoms- this is the appearance of new signs - delirium, hallucinations.

Signs of schizophrenia

Continuous forms of the disease include cases with a gradual progressive development of the disease process, with varying severity of both positive and negative symptoms. With a continuous course of the disease, its symptoms are observed throughout life from the moment of the disease. Moreover, the main manifestations of psychosis are based on two main components: delusions and hallucinations.

These forms of endogenous disease are accompanied by personality changes. A person becomes strange, withdrawn, commits ridiculous, illogical actions from the point of view of others. The range of his interests changes, new, previously unusual hobbies appear. Sometimes these are philosophical or religious teachings of a dubious nature, or fanatical adherence to the canons of traditional religions. At patients working capacity, social adaptation decreases. In severe cases, the emergence of indifference and passivity, a complete loss of interests is not excluded.

The paroxysmal course (recurrent or periodic form of the disease) is characterized by the occurrence of distinct attacks, combined with a mood disorder, which brings this form of the disease closer to manic-depressive psychosis, especially since mood disorders occupy a significant place in the picture of attacks. In the case of a paroxysmal course of the disease, the manifestations of psychosis are observed in the form of separate episodes, between which there are "bright" intervals of a relatively good mental state (with a high level of social and labor adaptation), which, being sufficiently long, can be accompanied by a complete recovery of working capacity (remission).

An intermediate place between these types of course is occupied by cases of a paroxysmal-progressive form of the disease, when, in the presence of a continuous course of the disease, the appearance of seizures is noted, the clinical picture of which is determined by syndromes similar to attacks of recurrent schizophrenia.

As mentioned earlier, the term "schizophrenia" was introduced by Erwin Bleuler. He believed that the main thing for describing schizophrenia is not the outcome, but the "basic disorder". He also singled out a complex of characteristic signs of schizophrenia, four "A", Bleuler's tetrad:

1. Associative defect - lack of associated purposeful logical thinking (currently called "alology").

2. A symptom of autism ("autos" - Greek - own - distancing from external reality, immersion in one's inner world.

3. Ambivalence - the presence in the patient's psyche of multidirectional affects love / hate at the same time.

4. Affective inadequacy - in a standard situation gives an inadequate affect - laughs when reporting the death of relatives.

Symptoms of schizophrenia

The French psychiatric school proposed a scale of deficient and productive symptoms, arranging them according to the degree of increase. German psychiatrist Kurt Schneider described rank I and rank II symptoms in schizophrenia. The "calling card" of schizophrenia is the symptoms of rank I, and now they are still "in use":

1. Sounding thoughts - thoughts acquire sonority, in fact they are pseudo-hallucinations.
2. "Voices" that argue among themselves.
3. Commentary hallucinations.
4. Somatic passivity (the patient feels that his motor acts are controlled).
5. "Taking out" and "implementation" of thoughts, shperrung - ("blockage" of thoughts), interruption of thoughts.
6. Broadcasting of thoughts (mental broadcasting - as if a radio receiver is turned on in the head).
7. Feeling "made" thoughts, their foreignness - "thoughts are not their own, they were put into the head." The same - with feelings - the patient describes that it is not he who feels hungry, but he is made to feel hungry.
8. Delusions of perception - a person interprets events in his symbolic key.

In schizophrenia, the boundaries between "I" and "not me" are destroyed. A person considers internal events external, and vice versa. Borders are loosened. Of the 8 signs above, 6 speak of this.

Views on schizophrenia as a phenomenon are different:

1. Schizophrenia is a disease - according to Kraepelin.
2. Schizophrenia is a reaction - according to Bangofer - the reasons are different, and the brain responds with a limited set of reactions.
3. Schizophrenia is a specific adaptation disorder (Amer. Laing, Shazh).
4. Schizophrenia is a special personality structure (based on a psychoanalytic approach).

Etiopathogenesis (origin, "origins") of schizophrenia

There are 4 "blocks" of theories:

1. Genetic factors. 1% of the population is stably sick; if one of the parents is sick, the risk that the child will also get sick is 11.8%. If both parents - 25-40% and above. In identical twins, the frequency of manifestation in both at the same time is 85%.
2. Biochemical theories: metabolic disorders of dopamine, serotonin, acetylcholine, glutamate.
3. Stress theory.
4. Psychosocial hypothesis.

Overview of some theories:

Stress (very different) affects the "flawed" personality - most often it is stress associated with the load of adult roles.

The role of parents: The American psychiatrists Bleytseg and Linds described the "schizophrenogenic mother". As a rule, this is a woman: 1. Cold; 2. non-critical; 3. Rigid (with a "freezing", delayed affect; 4. With confused thinking - often "pushing" the child to a severe course of schizophrenia.

There is a virus theory.

The theory that schizophrenia is a slowly progressive encephalitis-type debilitating process. The volume of the brain in patients suffering from schizophrenia is reduced.

In schizophrenia, the filtration of information, the selectivity of mental processes, and the pathopsychological direction are disturbed.

Men and women suffer from schizophrenia equally often, but the city dwellers - more often, the poor - more often (more stress). If the patient is male, the disease has an earlier onset and a more severe course, and vice versa.

The American health care system spends up to 5% of the budget on the treatment of schizophrenia. Schizophrenia is a disabling disease, it shortens the patient's life by 10 years. In terms of the frequency of causes of death in patients, cardiovascular diseases are in the first place, and suicide is in the second place.

Patients with schizophrenia have a large "margin of strength" in front of biological stress and physical exertion - they can withstand up to 80 doses of insulin, are resistant to hypothermia, rarely get ARVI and other viral diseases. It has been reliably calculated that "future patients" are born, as a rule, at the junction of winter-spring (March-April) - either because of the vulnerability of biorhythms, or because of the effects of infections on the mother.

Classification of variants of schizophrenia.

According to the type of flow, there are:

1. Continuously progressive schizophrenia.
2. Paroxysmal
a) paroxysmal-progredient (fur-like)
b) periodic (recurrent).

By stages:

1. The initial stage (from the first signs of the disease (asthenia) to the manifest signs of psychosis (hallucinations, delusions, etc.). There may also be hypomania, subdepression, depersonalization, etc.
2. Manifestation of the disease: a combination of deficient and productive symptoms.
3. Final stage. A pronounced predominance of deficient symptoms over productive ones and the freezing of the clinical picture.

According to the degree of progression (development rate):

1. Rapidly progressive (malignant);
2. Medium progredient (paranoid form);
3. Low-progressive (sluggish).

The exception is recurrent schizophrenia.

Description of some types:

Malignant schizophrenia: manifests itself between the ages of 2 and 16 years. It is characterized by a very short initial stage - up to a year. The manifest period is up to 4 years. Peculiarities:
a) In premorbid (i.e., in a state preceding the disease), a schizoid personality (closed, uncommunicative, fearful of the outside world of a person);
b) Productive symptoms immediately reach a high level;
c) At the 3rd year of the disease, an apathetic-abulic syndrome is formed (vegetabels - "vegetable life" - while this condition can be reversible at the time of severe stress - for example, in a fire);
d) Treatment is symptomatic.

Intermediate type of schizophrenia: The initial period lasts up to 5 years. Strange hobbies, hobbies, religiosity appear. Get sick at the age of 20 to 45 years. In the manifest period - either a hallucinatory form or delusional. This period lasts up to 20 years. At the final stage of the disease - shrapnel delirium, speech is preserved. The treatment is effective, it is possible to achieve drug remissions (temporary improvements in well-being). With continuous-progredient schizophrenia, hallucinatory-delusional symptoms significantly predominate over affective ones (violations of the emotional-volitional sphere); in paroxysmal, affective symptoms predominate. Also, in paroxysmal remissions, they are deeper and can be spontaneous (spontaneous). With a continuously progressive patient, the patient is hospitalized 2-3 times a year, with a paroxysmal - up to 1 time in 3 years.

Sluggish, neurosis-like schizophrenia: Age of onset is 16 to 25 years on average. There is no clear boundary between the initial and manifest periods. Neurosis-like phenomena dominate. Schizophrenic psychopathization is observed, but the patient can work, maintain family and communication ties. At the same time, it is clear that the person is "distorted" by the disease.

What are the negative and positive symptoms?

Let's start with the negatives:

1. Engin Bleiler singled out associative defect;
Stransky - interpsychic ataxia;
Also - schism.

All this is the loss of coherence, the integrity of mental processes -
a) in thinking;
b) in the emotional sphere;
c) in acts of will.

The processes themselves are fragmented, and even within the processes themselves there is a "mess". Schism is an unfiltered product of thinking. Healthy people also have it, but it is controlled by consciousness. In patients, it is observed in the initial stage, but, as a rule, disappears with the advent of hallucinations and delusions.

2. Autism. A patient with schizophrenia experiences anxiety and fear when communicating with the outside world and wants to distance himself from any contact. Autism - flight from contacts.

3. reasoning- the patient speaks, but does not move towards the goal.

4. Apathy- Increasing loss of emotional response - an ever smaller number of situations causes an emotional reaction. At first, rationalization is observed instead of immediate emotions. The first thing that disappears is interests and hobbies. ("Sergey, my aunt is coming" - "we'll come and meet you"). Adolescents behave like little old men - they seem to be reasonably responsible, but behind this "reasonableness" there is a clear impoverishment of emotional reactions; ("Vitalik, brush your teeth" - "why?") I.e. does not refuse or disagree, but tries to rationalize. If you give an argument why you need to brush your teeth, there will be a counterargument, the conviction can drag on indefinitely, because. the patient is not going to discuss anything in fact - he just resonates.

5. Abulia(according to Kraepelin) - the disappearance of the will. In the early stages, it looks like increasing laziness. First - at home, at work, then in self-service. Patients lie more. More often, it is not apathy, but impoverishment; not abulia, but hypobulia. Emotions in patients with schizophrenia are stored in one isolated "reserve zone", which in psychiatry is called parabulia. Parabulia can be the most diverse - one of the patients abandoned work and walked around the cemetery for months, drawing up his plan. "Labor" took up a large volume. Another - counted all the letters "H" in "War and Peace". The third - dropped out of school, walked down the street, collected animal excrement and at home carefully attached them to the stand, as entomologists do with butterflies. Thus, the patient resembles a "mechanism running idle."

Positive or productive symptoms:

1. Auditory pseudohallucinations(the patient hears "voices", but perceives them not as really existing in nature, but accessible only to him, "induced" by someone, or "descent from above"). It is usually described that such "voices" are heard not as usual, by the ear, but by the "head", "brain".

2. Syndrome of mental automatisms(Kandinsky-Clerambault), which includes:
a) Delusions of persecution (patients in this state are dangerous, because they can arm themselves in order to defend themselves from imaginary pursuers, and injure anyone who is considered as such; or attempt suicide in order to "end it");
b) delirium of influence;
c) auditory pseudohallucinations (described above);
d) Mental automatism - associative (feeling that thoughts are "made"); senestopathic (feeling that feelings are "made"); motor (feeling that certain movements that he makes are not his, but imposed on him from the outside, he is forced to do them) .

3. Catatonia, hebephrenia- freezing in one position, often uncomfortable, for long hours, or vice versa - sharp disinhibition, foolishness, antics.

According to neurogenetic theories, the productive symptomatology of the disease is due to dysfunction of the caudate nucleus system of the brain, the limbic system. Mismatch in the work of the hemispheres, dysfunction of the fronto-cerebellar connections are found. On CT (computed tomography of the brain), you can detect the expansion of the anterior and lateral horns of the ventricular system. With nuclear forms of the disease, the voltage from the frontal leads is reduced on the EEG (electroencephalogram).

Diagnosis of schizophrenia

The diagnosis is made on the basis of the identification of the main productive symptoms of the disease, which are combined with negative emotional and volitional disorders, leading to the loss of interpersonal communications with a total observation period of up to 6 months. The most important in the diagnosis of productive disorders is the identification of symptoms of influence on thoughts, actions and mood, auditory pseudohallucinations, symptoms of openness of thought, gross formal thought disorders in the form of discontinuity, catatonic movement disorders. Among the negative violations, attention is paid to the reduction of energy potential, alienation and coldness, unreasonable hostility and loss of contacts, social decline.

At least one of the following signs must be present:

"Echo of thoughts" (sounding of one's own thoughts), insertion or withdrawal of thoughts, openness of thoughts.
Delusions of influence, motor, sensory, ideational automatisms, delusional perception.
Auditory commentary true and pseudo hallucinations and somatic hallucinations.
Delusional ideas that are culturally inappropriate, ridiculous, and grandiose in content.

Or at least two of the following:

Chronic (more than a month) hallucinations with delusions, but without pronounced affect.
Neologisms, sperrungs, broken speech.
catatonic behavior.
Negative symptoms, including apathy, abulia, impoverishment of speech, emotional inadequacy, including coldness.
Qualitative behavioral changes with loss of interest, lack of focus, autism.

Diagnosis of paranoid schizophrenia is put in the presence of general criteria for schizophrenia, as well as the following signs:

1. dominance of hallucinatory or delusional phenomena (ideas of persecution, relationship, origin, thought transmission, threatening or haunting voices, hallucinations of smell and taste, senesthesia);
2. catatonic symptoms, flattened or inadequate affect, speech rupture may be presented in a mild form, but do not dominate the clinical picture.

Diagnosis of the hebephrenic form is put in the presence of general criteria for schizophrenia and:

one of the following signs;

• distinct and persistent flattening or superficiality of affect,
• a distinct and persistent inadequacy of affect,

one of the other two signs;

• lack of purposefulness, concentration of behavior,
• distinct disturbances of thinking, manifested in incoherent or broken speech;

hallucinatory-delusional phenomena may be present in a mild form, but do not determine the clinical picture.

Diagnosis of the catatonic form is placed if the general criteria for schizophrenia are met, and at least one of the following signs has been present for at least two weeks:

• stupor (a distinct decrease in reaction to the environment, spontaneous mobility and activity) or mutism;
• arousal (outwardly meaningless motor activity not caused by external stimuli);
• stereotypy (voluntary adoption and retention of meaningless and pretentious postures, performance of stereotyped movements);
• negativism (outwardly unmotivated resistance to appeals from the outside, the fulfillment of the opposite of what is required);
• rigidity (maintenance of the posture, despite external attempts to change it);
• waxy flexibility, stiffening of the limbs or body in poses given from the outside);
• automatism (immediate following of instructions).

Photos of patients with catatonic schizophrenia

undifferentiated form is diagnosed when the condition meets the general criteria for schizophrenia but not the specific criteria for individual types, or the symptoms are so numerous that they meet the specific criteria for more than one subtype.

Diagnosis of post-schizophrenic depression set if:

1. the state during the last year of observation met the general criteria for schizophrenia;
2. at least one of them is retained; 3) the depressive syndrome must be so protracted, severe and unfolding as to meet the criteria for at least a mild depressive episode (F32.0).

For diagnosis of residual schizophrenia the condition must in the past meet the criteria common for schizophrenia, not already detected at the time of the examination. In addition, at least 4 of the following negative symptoms must have been present within the last year:

1. psychomotor retardation or reduced activity;
2. distinct flattening of affect;
3. passivity and reduced initiative;
4. impoverishment of the volume and content of speech;
5. decrease in the expressiveness of non-verbal communication, manifested in facial expressions, eye contact, voice modulations, gestures;
6. decrease in social productivity and attention to appearance.

Diagnosis of a simple form of schizophrenia is based on the following criteria:

1. a gradual increase in all three of the following signs for at least a year:

• distinct and persistent changes in some premorbid personality traits, manifested in a decrease in motives and interests, purposefulness and productivity of behavior, withdrawal into oneself and social isolation;
• negative symptoms: apathy, impoverishment of speech, decrease in activity, a distinct flattening of affect, passivity, lack of initiative, decrease in non-verbal characteristics of communication;
• a distinct decrease in productivity at work or school;

1. the state never corresponds to the features common to paranoid, hebephrenic, catatonic and undifferentiated schizophrenia (F20.0-3);
2. there are no signs of dementia or other organic brain damage (FO).

The diagnosis is also confirmed by the data of a pathopsychological study, clinical and genetic data on the burden of schizophrenia in first-degree relatives are of indirect importance.

Pathopsychological tests in schizophrenia.

In Russia, unfortunately, the psychological examination of the mentally ill is not very developed. Although honey. There are psychologists on staff in hospitals.

The main diagnostic method is a conversation. The logical sequence of thinking inherent in a mentally healthy person in a patient with schizophrenia is in most cases upset, and associative processes are violated. As a result of such violations, the patient seems to speak consistently, but his words do not have a semantic connection with each other. For example - the patient says that he is "hunted by the laws of justice of the sages in order to drag lambs with straight noses around the world."

As tests, they are asked to explain the meanings of expressions and sayings. Then you can "dig out" the formality, the earthiness of judgments, the lack of understanding of the figurative meaning. For example, "they cut down the forest, the chips fly" - "well, yes, the tree is made of fibers, they break off when struck with an ax." Another patient, when asked to explain what the expression “This man has a heart of stone” means, says this: “Among the times of growth, there is heart layering, and this is the appearance of human growth.” The above phrases are incomprehensible. This is a typical example of "speech discontinuity". In some cases, speech is reduced to the pronunciation of individual words and phrases without any sequence. For example, "...smoke pouring...there will be no place...the kingdom of heaven...it's wrong to buy water...two without a name...six crowns...cut a lasso and a cross..." - this is the so-called verbal okroshka, or verbal salad. They may be asked to draw the meaning of the phrase "delicious lunch." Where an ordinary person draws a chicken leg, a steaming bowl of soup, or a plate with a fork and knife, a schizophrenic patient draws two parallel lines. To the question - "what is it?" - replies that "lunch is delicious, everything is high, harmony, that's how these lines are" Another test - to exclude the fourth extra - from the list "jackdaw, tit, crow, plane" - may either not exclude the plane (all from the list flies), or to exclude, but relying only on signs known to him ("the first three from the list can land on the wires, but the plane cannot." And not living / non-living, like ordinary people).

Predictions for schizophrenia.

We will reveal four types of forecasts:

1. General prognosis of the disease - refers to the time of onset of the end state and its characteristics.

2. Social and labor forecast.

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

4. Forecast of the risk of suicide and homicide (suicide and murder).

About 40 factors have been identified that make it possible to determine the prognosis of the course of the disease. Here are some of them:

1. Sex. The male is an unfavorable factor, the female is favorable (nature is designed so that women are the keepers of the population, while men are researchers, they account for more mutations).

2. The presence of concomitant organic pathologies is a poor prognosis.

3. Hereditary burden for schizophrenia - unfavorable prognosis.

4. Schizoid accentuation of character before the onset of the disease.

5. Acute onset is a good prognostic sign; erased, "smeared" - bad.

6. Psychogenic "starting" mechanism - good, spontaneous, not having an obvious reason - bad.

7. The predominance of the hallucinatory component is bad, the affective component is good.

8. Sensitivity to therapy during the first episode - good, no - bad.

9. A large frequency and duration of hospitalizations is a poor prognostic sign.

10. The quality of the first remissions - if the remissions are complete, good (meaning remissions after the first episodes). It is important that there be no or minimal negative and positive symptoms during remission.

40% of patients with schizophrenia commit suicidal acts, 10-12% die from suicide.

List of risk factors for suicide in schizophrenia:

1. Male gender.
2. Young age.
3. Good intelligence.
4. First episode.
5. History of suicide.
6. The predominance of depressive and anxiety symptoms.
7. Imperative hallucinosis (hallucinations ordering to perform certain actions).
8. The use of psychoactive substances (alcohol, drugs).
9. The first three months after discharge.
10. Inadequately small or large doses of drugs.
11. Social problems in connection with the disease.

Risk factors for homicide (attempted murder):

1. History of (previously) criminal assault episodes.
2. Other criminal acts.
3. Male gender.
4. Young age.
5. Use of psychoactive substances.
6. Hallucinatory-delusional symptoms.
7. Impulsivity.

Sluggish schizophrenia

According to statistics, half of patients with schizophrenia "possess" it in a sluggish form. This is a certain category of people that is difficult to outline. Recurrent schizophrenia also occurs. Let's talk about them.

By definition, sluggish schizophrenia is schizophrenia that does not show pronounced progression throughout and does not show manifest psychotic phenomena, the clinical picture is represented by disorders of the light "registers" - neurotic personality disorders, asthenia, depersonalization, derealization.

The names of sluggish schizophrenia accepted in psychiatry: mild schizophrenia (Kronfeld), non-psychotic (Rozenshtein), Current without a change in character (Kerbikov), microprocessual (Goldenberg), rudimentary, sanatorium (Konnaibeh), prephase (Yudin), slow-flowing (Azelenkovsky), larvated , hidden (Snezhnevsky). You can also find the following terms:
failed, amortized, ambulatory, pseudo-neurotic, occult, non-regressive.

Sluggish schizophrenia has certain stages, stages:

1. Latent (debut) - proceeds very covertly, latently. As a rule, at the age of puberty, in adolescents.

2. Active (manifest) period. The manifesto never reaches the psychotic level.

3. Stabilization period (in the first years of the disease, or after several years of the disease).
In this case, the defect is not observed, there may even be a regression of negative symptoms, its reverse development. However, there may be a new push at the age of 45-55 years (involutionary age). General characteristics:
Slow, long-term development of the stages of the disease (however, it can stabilize at an early age); long subclinical course in the latent period; gradual reduction of disorders in the period of stabilization.

Forms, variants of low-progressive schizophrenia:

1. Asthenic variant - symptoms are limited by the level of asthenic disorders. This is the softest level.
At the same time, asthenia is atypical, without a "symptom of a match", irritability - in this case, selective exhaustion of mental activity is observed. There are also no objective reasons for asthenic syndrome - somatic disease, organic pathology in premorbidity. The patient gets tired of everyday everyday communication, ordinary affairs, while he is not exhausted by other activities (communication with antisocial personalities, collecting, and often pretentious). This is a kind of hidden schism, a splitting of mental activity.

2. Form with obsession. Similar to obsessive compulsive disorder. However, in schizophrenia, no matter how hard we try, we will not find psychogenesis and personality conflict. Obsessions are monotonous and emotionally not saturated, "not charged". At the same time, these obsessions can be overgrown with a large number of rituals performed without the emotional involvement of a person. Characterized by monoobsessions (monothematic obsession).

3. Form with hysterical manifestations. Characterized by "cold hysteria". This is a very "selfish" schizophrenia, while it is exaggerated, grossly selfish, exceeding the hysteria in a neurotic. The rougher it is, the worse, the deeper the violation.

4. With depersonalization. In human development, depersonalization (violation of the "me - not me" boundaries) may be the norm in adolescence; in schizophrenia, it goes beyond this.

5. With dysmorphic experiences ("my body is ugly, my ribs are too sticky, I'm too thin/fat, my legs are too short, etc.). This also occurs in adolescence, but in schizophrenia there is no emotional involvement in the experience." Defects" frilly - "one side is more frilly than the other." Anorexia nervosa syndrome at an early age also belongs to this group.

6. Hypochondriacal schizophrenia. Non-delusional, non-psychotic level. Typical for adolescence and involutionary age.

7. Paranoid schizophrenia. Reminds me of a paranoid personality disorder.

8. With a predominance of affective disorders. Possible as hypothymic variants (subdepression, but without intellectual retardation). At the same time, a schism is often seen between a reduced background of mood and intellectual, motor activity, a volitional component. Also - hypochondriacal subdepression with an abundance of senestopathies. Subdepression with a tendency to introspection, introspection.
Hyperthymic manifestations: hypomania with a one-sided character of enthusiasm for one activity. "Zigzags" are characteristic - a person works, is full of optimism, then a recession for several days - and works again. Schizis variant - hypomania with simultaneous health complaints.

9. Variant of unproductive disorders. "Easy Option" Symptoms are limited to negative. There is a gradual, increasing defect over the years.

10. Latent sluggish schizophrenia (according to Smulevich) - everything that was listed above, but in the most mild, outpatient form.

Defects in sluggish schizophrenia:

1. A defect of the Verschreuben type (with German strangeness, eccentricity, eccentricity) - described by Krepeleny.
Outwardly - disharmony of movements, angularity, a certain juvenile ("childhood"). The unmotivated seriousness of facial expression is characteristic. There is a certain shift with the acquisition earlier (before the disease) of traits not characteristic of this personality. In clothes - slovenliness, absurdity (short trousers, bright hats, clothes, as from the century before last, randomly selected things, etc.). Speech - unusual, with a selection of peculiar words and speech turns, "stuck" on minor details is characteristic. There is a preservation of mental and physical activity, despite the eccentricity (there is a schism between social autism and lifestyle - patients walk a lot, communicate, but in a peculiar way).

2. Psychopathic defect (pseudopsychopatization according to Smulevich). The main component is schizoid. An expansive schizoid, active, "gushing" with overvalued ideas, emotionally charged, with "autism inside out", but at the same time flattened, not solving social problems. In addition, there may be a hysterical component.

3. Reduction of the energy potential of a shallow degree of severity (passive, live within the house, do not want and cannot do anything). Similar to the typical reduction in energy potential in schizophrenia, but to a much less pronounced degree.

These people often begin to resort to psychoactive substances, more often to alcohol. At the same time, emotional flatness decreases, the schizophrenic defect decreases. The danger, however, is that alcoholism and drug addiction become uncontrollable, since the stereotype of their response to alcohol is atypical, alcohol often does not bring relief, the forms of intoxication are expansive, with aggression and brutality. However, alcohol is indicated in small doses (old-school psychiatrists prescribed it to their patients with sluggish schizophrenia).

And finally - recurrent, or periodic schizophrenia.

It is rare, in particular due to the fact that it is not always possible to diagnose it in time. In the International Classification of Diseases (ICD), recurrent schizophrenia is designated as schizoaffective disorder. This is the most complex form of schizophrenia in terms of its symptoms and structure.

Stages of occurrence of recurrent schizophrenia:

1. The initial stage of general somatic and affective disorders (subdepression with severe somatization - constipation, anorexia, weakness). The presence of overvalued (ie, based on real, but grotesquely exaggerated) fears (for work, relatives) is characteristic. Lasts from several days to several months (usually 1-3 months). This may be the limit. The beginning is adolescence.

2. Delusional affect. Fuzzy, undeveloped fears of delusional, paranoid content (for oneself, for loved ones) appear. There are few delusions, they are sketchy, but there is a lot of affective charge and motor components - thus, this can be attributed to an acute paranoid syndrome. Beginning changes in self-consciousness are characteristic. There is a certain alienation of one's behavior, depersonalization manifestations of a shallow register. This stage is extremely labile, symptoms may fluctuate.

3. Stage of affective-delusional depersonalization and derealization. Disorders of self-awareness sharply increase, a delusional perception of the environment appears. Delusions of intermetamorphosis - "everything around is rigged." False recognition appears, a symptom of twins, there are automatisms ("I am controlled"), psychomotor agitation, substupor.

4. Stage of fantastic affective-delusional depersonalization and derealization. Perception becomes fantastic, paraphrenization of symptoms takes place ("I'm in the school of space reconnaissance and I'm being tested"). The disorder of self-awareness continues to worsen (“I am a robot, they manage me”; “I manage the hospital, the city”).

5. Illusory-fantastic derealization and depersonalization. The perception of oneself and reality begin to suffer rudely up to illusions and hallucinations. In fact, this is the beginning of a oneiroid stupefaction ("I am me, but now I am a technical device - pockets are special devices for disks"; "a policeman says - I hear him, but this is a voice that controls everything on Earth").

6. Stage of classical, true oneiroid clouding of consciousness. The perception of reality is completely disrupted, it is unrealistic to make contact with the patient (only for a short time - due to the lability of the processes). There may be motor activity dictated by experienced images. Self-consciousness is violated (“I am not me, but an animal of the Mesozoic era”; “I am a machine in the struggle between machines and people”).

7. Stage of amental-like obscuration of consciousness. In contrast to the oneiroid, psychopathological experiences of reality are extremely impoverished. Amnesia of experience and images is complete (with oneiroid - no). Also - confusion, severe catatonic symptoms, fever. This is the pre-phase of the next stage. The prognosis is unfavorable. (There is also a separate form - "Febrile schizophrenia"). The main "psychiatric" remedy in this case is electro-convulsive therapy (ECT) - up to 2-3 sessions per day. This is the only way to break this state. There is a 5% chance of improvement. Without these measures, the prognosis is 99.9% poor.

All of the above levels can be an independent picture of the disease. As a rule, from an attack to an attack, the condition worsens until it “freezes” at some stage. Recurrent schizophrenia is a low-progressive form, therefore there is no complete recovery between attacks, but remissions are long, the manifestations of the disease are hardly noticeable. The most common outcome is a reduction in energy potential, patients become passive, fenced off from the world, while maintaining, nevertheless, often a warm atmosphere for family members. In many patients, through recurrent schizophrenia after 5-6 years, it can turn into a fur coat. In its pure form, recurrent schizophrenia does not lead to a permanent defect.

Treatment of schizophrenia.

General Methods:

I. Biological therapy.

II. Social therapy: a) psychotherapy; b) methods of social rehabilitation.

Biological methods:

I "Shock" methods of therapy:

1. Insulin-coma therapy (introduced by German psychiatrist Zakel in 1933);

2. Convulsive therapy (with the help of camphor oil injected under the skin - the Hungarian psychiatrist Meduna in 1934) - is not used now.

3) electro-convulsive therapy (Cerletti, Beni in 1937). Mood disorders ECT treats very effectively. With schizophrenia - with suicidal behavior, with catatonic stupor, with resistance to drug therapy.

4) Detoxification therapy;

5) Diet-unloading therapy (with sluggish schizophrenia);

6) Deprivation (deprivation) of sleep and phototherapy (for affective disorders);

7) Psychosurgery (in 1907, Bechtrinwa's staff performed a lobotomy; in 1926, the Portuguese Monica performed a prefrontal leucotomy. Monitz was later wounded by a patient with a pistol shot after he performed an operation on him);

8) Pharmacotherapy.

Drug groups:

a) neuroleptics;
b) Anxiolytics (reducing anxiety);
c) Normotimics (regulating the affective sphere);
d) antidepressants;
e) nootropics;
e) psychostimulants.

In the treatment of schizophrenia, all of the above groups of drugs are used, but antipsychotics are in the 1st place.

General principles of drug treatment of schizophrenia:

1. Biopsychosocial approach - any patient suffering from schizophrenia needs biological treatment, psychotherapy and social rehabilitation.

2. Pay special attention to psychological contact with the doctor, because patients with schizophrenia have the lowest interaction with the doctor - they are distrustful, they deny the presence of the disease.

3. Early initiation of therapy - before the onset of the manifest stage.

4. Monotherapy (where you can prescribe 3 or 5 drugs, choose 3, so you can "track" the effect of each of them);

5. Long duration of treatment: relief of symptoms - 2 months, stabilization of the condition - 6 months, formation of remission - a year);

6. The role of prevention - special attention is paid to drug prevention of exacerbations. The more exacerbations, the more severe the disease. In this case, we are talking about secondary prevention of exacerbations.

The use of antipsychotics is based on the dopamine theory of pathogenesis - it was believed that patients with schizophrenia had too much dopamine (a precursor of norepinephrine), and it should be blocked. It turned out that there is not more of it, but the receptors for it are more sensitive. At the same time, violations of serotonergic mediation, acetylcholine, histamine, glutamate were found out, but the dopamine system reacts faster and stronger than the others.

The gold standard for the treatment of schizophrenia is haloperidol. In terms of power, it is not inferior to subsequent drugs. Classic antipsychotics, however, have side effects: they have a high risk of extrapyramidal disorders, and they act very brutally on all dopamine receptors. Recently, atypical antipsychotics have appeared: Clozepine (leponex) - the first atypical antipsychotic to appear; the most famous at present:

1. Respiredon;
2. Alanzepine;
3. Clozepine;
4. Quetiopin (Serroquel);
5. Abilefay.

There is a prolonged version of drugs that allows you to achieve remissions with more rare injections:

1. Moditen Depot;
2. Haloperidol-decanoate;
3. Rispolept-consta (reception 1 time in 2-3 weeks).

As a rule, when prescribing a course, oral drugs are preferable, since the introduction of the drug into a vein, into the muscle is associated with violence and causes peak blood concentrations very quickly. Therefore, they are used mainly for the relief of psychomotor agitation.

Hospitalization.

In schizophrenia, hospitalization is indicated in acute conditions - refusal to eat for a week or more, or leading to a loss of body weight by 20% of the original or more; the presence of imperative (commanding) hallucinosis, suicidal thoughts and tendencies (attempts), aggressive behavior, psychomotor agitation.

Because people with schizophrenia are often unaware that they are ill, it is difficult or even impossible to persuade them to seek treatment. If the patient's condition worsens, and you can neither convince nor force him to be treated, then you may have to resort to hospitalization in a psychiatric hospital without his consent. The primary purpose of both involuntary hospitalization and the laws governing it is to ensure the safety of the acutely ill patient and those around him. In addition, the tasks of hospitalization also include ensuring the timely treatment of the patient, even if against his desire. After examining the patient, the district psychiatrist decides under what conditions to treat: the patient's condition requires urgent hospitalization in a psychiatric hospital, or outpatient treatment can be limited.

Article 29 of the Law of the Russian Federation (1992) " On psychiatric care and guarantees of the rights of citizens in its provision" clearly regulates the grounds for involuntary hospitalization in a psychiatric hospital, namely:

"A person suffering from a mental disorder may be hospitalized in a psychiatric hospital without his consent or without the consent of his legal representative before the decision of the judge, if his examination or treatment is possible only in hospital conditions, and the mental disorder is severe and causes:

1. his immediate danger to himself or others, or
2. his helplessness, that is, his inability to satisfy the basic needs of life on his own, or
3. significant harm to his health due to the deterioration of his mental state if the person is left without psychiatric care.

Treatment during remission

During the period of remission, maintenance therapy is mandatory; without this, a worsening of the condition is inevitable. As a rule, patients after discharge feel much better, consider that they are cured completely, stop taking drugs, and the vicious circle starts again. This disease is not completely cured, however, with adequate therapy, it is possible to achieve stable remission against the backdrop of maintenance treatment.

Do not forget that often the success of treatment depends on how quickly after the exacerbation or initial stage there was an appeal to a psychiatrist. Unfortunately, relatives who have heard about the "horrors" of a psychiatric clinic oppose the hospitalization of such a patient, believing that "everything will pass by itself." Alas... Spontaneous remissions are practically not described. Therefore, they turn later, but in a more difficult situation.

Criteria for remission: the disappearance of delusions, hallucinations (if any), the disappearance of aggression or suicidal attempts, if possible, social adaptation. In any case, the decision on discharge is made by the doctor, as well as on hospitalization. The task of the relatives of such a patient is to cooperate with the doctor, informing him of all the nuances of the patient's behavior, without hiding or embellishing anything. And also - monitor the intake of drugs, since such people do not always fulfill the appointments of a psychiatrist. In addition, success also depends on social rehabilitation, and half the success in this is the creation of a comfortable atmosphere in the family, and not an "exclusion zone". Believe me, patients of this profile very subtly feel the attitude towards themselves and react accordingly.

If you take into account the cost of treatment, disability payments and sick leave, then schizophrenia can be called the most expensive of all mental illnesses.

Psychiatrist A.V. Khodorkovsky

Modern people often have mental illness. One of the most common is schizophrenia. It is still unexplored, despite the active development of psychiatry. However, at the moment there is already a lot of information about it.

Medical history of schizophrenia

The very first mention of the disease falls on the 17th century BC on the ancient Egyptian papyrus in the Book of Hearts. This indicates that even ancient people were studying issues related to mental disorders. The description of the disease schizophrenia was also put forward in the Middle Ages. This is evidenced by ancient medical texts.

In 1880, the Russian psychiatrist Viktor Khrisanfovich Kandinsky first described the disease, giving it the name "ideophrenia". The disease was described by Emil Kraepelin in 1893 as an independent disorder of the human soul. What is schizophrenia disease? Kraepelin was the first to divide it into early dementia and manic depression. This observation plays a significant role in the scientific community so far. Now outpatient medical histories are started for people suffering from this pathology. Schizophrenia in 1908 was named an independent disease. Eigen Bleuler, a Swiss psychiatrist, introduces the concept to the scientific community. According to his research, the deviation can appear both in adolescence and in an adult. The most significant statement of the scientist indicates that schizophrenia is a malfunction in the work of associative thinking. Eigen proposed several types of illness:

• Strong-willed. Difficulties in choosing any meaningful decision. Since a person cannot make a choice, this forces him to refuse to make decisions in general.
• Emotional. Thinking, which is characterized by a positive and neutral attitude towards objects from the surrounding reality (people, objects, events).
• Intellectual. Conflicts of diverse ideas and reasoning in the mind. They often conflict and are mutually exclusive.

After a short period of time, psychiatrists recognized this concept. What kind of disease schizophrenia is now established. However, the question of occurrence, treatment and signs for which it is necessary to make a diagnosis is still unknown.

What is an ailment

According to statistics, about 3% of the world's population is affected by this disease. What is schizophrenia disease? This is characterized by a variety of hallucinations and distortions of thinking. Some people believe that schizophrenia is a split personality, but this is not true. A sick person does not understand what is happening around him. A complete confusion is going on in the head: thoughts, events, imaginary incidents are mixed with each other. Everything that a person perceives from the surrounding world is a chaotic set of various pictures, images and sounding phrases. One of the severe forms is continuous paranoid schizophrenia. Often patients completely deny their disease and consider themselves healthy people. Sometimes there are patients who build their own separate reality in addition to the one that exists in the world.

Also, schizophrenia is characterized by its combination with other deviations. These include various depressions and anxiety disorders. Often among schizophrenics you can meet alcoholics and drug addicts. Patients are suicidal. As a result, a person may lose their home, work and contacts with people.

Causes of the disease

At the moment, scientists do not have exact statements, which is why the disease appeared. Is schizophrenia hereditary or not? Experts answer this question that it can appear not only because of the genetic factor. There are many possible causes of schizophrenia:

• Heredity. This assumption appeared in the last century, when people believed that schizophrenia could only manifest itself by inheritance. The likelihood of the disease increases with the proximity of a relative with schizophrenia. Modern research states that the risk of transmission of a deviation from one schizophrenic parent is 12%, and from two - 20%.
• Developmental disorders of the brain. This assumption is based on various pathologies of the brain. The bottom line is that the deviations do not progress and are mild. However, in the future, because of them, the disease can develop.
• Psychological aspects. This theory was proposed by Sigmund Freud. Its meaning is to restore the patient to his former state, which was lost.
• body intoxication. Psychiatrists believe that unsplit products of protein metabolism can be the causes of the disease. It is believed that the brain undergoes oxygen starvation.
• Cognitive impairment. In this case, schizophrenia appears due to the fact that a person tries to describe his feelings to relatives. As soon as the patient begins to hear voices, he tells loved ones. However, they do not understand it and deny it. As a result, schizophrenia develops.

Science is only getting closer to describing the causes of the disease, but at the moment there is not enough information. It is known that patients have impaired perception and sensory feelings.

Signs of the disease

Often, people with schizophrenia have many disorders that can be used to identify the disease. What kind of disease is schizophrenia and how does the patient behave? Such a person may have different thoughts from speech, sound hallucinations, delirium may appear. Often patients are socially isolated due to the resulting paranoia, hallucinations, delusions and apathy. Very rarely, schizophrenics can remain silent and stand still. Also, patients stop doing normal activities, such as washing their hair or brushing their teeth. A person expresses little emotion, sometimes it will be difficult to understand what he feels. However, these signs are not enough to diagnose a mental disorder.

Stages of the disease

Each period of the course of the disease is characterized by different signs and symptoms. There are 4 stages in total:

• premorbid stage. During it, a person's basic personality traits change. The person begins to behave suspiciously and inadequately. Also, the patient begins to strangely express his emotions.
• prodromal stage. A person begins to withdraw from society and his family. The patient is isolated from the outside world. The traits of an absent-minded person also appear.
• First psychotic episode. During it, the schizophrenic develops auditory hallucinations, obsessions and delusions.
• remission stage. The characteristic features of this period are the disappearance or weakening of all symptoms. This is followed by a strong aggravation.

Also, patients may develop a defect, an incurable stage of the disease. Psychiatrists believe that this is the last stage of mental illness. They are called deviations in the personality and psyche of a schizophrenic. In patients, all needs are reduced, apathy, indifference and serious disturbances in thinking appear.

Symptoms of schizophrenia

In patients with this, disorders of thinking and perception, as well as emotional disturbances, are observed. Also in schizophrenia, the stages of the disease play a significant role in the symptoms. Often, their duration should be about a month, and for a more accurate diagnosis, a specialist should observe a person for six months. Distinguish between positive and negative symptoms. The former include signs that were not observed in a person before, but they appeared at the stage of development of schizophrenia. The word "positive" means the appearance of new symptoms:

• Rave.
• The appearance of hallucinations.
• Excited state.
• Strange behavior.
• Illusions.

The negative symptoms of schizophrenia are the absence of a normal manifestation of emotions and character traits. The personality of the patient is erased due to violations of the mental state and processes in the body. The most common negative symptoms:

• Decreased volitional activity. A schizophrenic patient ignores elementary hygiene standards. It also reduces appetite and food cravings. Attraction to the opposite sex completely disappears. In severe cases, schizophrenia can lead to a complete loss of interest in life and apathy.
• Isolation from society. Such a sign may appear very late. A person strives not to be in a team, stops communicating with relatives and friends.
• Depressed state. Patients feel a state close to depression. They develop apathy and indifference to the world around them.

Also, patients with schizophrenia become very passive, it is difficult for them to make decisions. Most do not respond to difficulties and believe that nothing can be changed in difficult situations.

Diagnosis of the disease

The diagnosis can only be made by a specialist who relies on a complete psychiatric diagnosis. It includes a general assessment of the patient's condition by questioning. As we have already found out, even specialists cannot give an exact answer to the question: is schizophrenia a congenital or acquired disease? After all, it can appear both due to a genetic factor, and as a result of brain dysfunctions throughout life. Family data is also collected, because very often this disease is caused by genetics. Another specialist conducts a complete medical diagnosis to rule out other diseases. After all, some diseases have similar symptoms. To make a diagnosis, you need to determine the symptoms that persist for a month:

• Auditory or visual hallucinations.
• apathy, depression, silence.
• Deviations from the usual behavior in the family, at work, in educational institutions.
• Speech and thinking disorders.
• Delusional states.

Schizophrenia is characterized by loss of connection with reality for a long time. However, there are many similar mental disorders, such as short psychotic episodes, mania and depression. Also, the patient's symptoms may occur due to the use of psychoactive substances: alcohol, heroin, amphetamine, cocaine.

Differences in women and men

Representatives of the stronger sex, suffering from a disease, may lose all their cravings and interest in life. Sometimes schizophrenia can wax and wane. The most basic signs in men:

• The appearance of hallucinations.
• Delusional state.
• Low level of critical attitude to life.

Men mystify all occurring events or objects. An inadequate reaction to what is happening may appear: tears or laughter. It also increases anxiety and arousal.

In women, the very first manifestations of the disease can appear at the age of 20, less often at 30. What is the first sign of schizophrenia in women? Behavior that becomes antisocial. They often lose their hobbies and jobs due to behavioral problems. Also, women often have apathy and indifference to the world around them. Main features:

• Aggressive behavior.
• Irritability.
• auditory hallucinations.
• Obsession.

Women may cry often and try to draw a lot of attention to themselves. Also, many complain of non-existent pain. behavior changes dramatically. The symptoms of schizophrenia in women do not differ much from the symptoms in men.

Manifestations at an early age

Schizophrenia is one of the most common diseases in adolescents. It occurs in every fifth patient with mental disorders. Symptoms and signs of schizophrenia in adolescents are similar to those in older people, but have their own characteristics. The disease may appear due to factors:

• genetic predisposition.
• Deviations nervous system.
• The impact of infections on the fetus during gestation by the mother.
• Substance use and childhood alcoholism.
• Many quarrels, scandals and conflicts in the family.
• Insufficient attention to the teenager.

In children, unlike adults, negative symptoms are more pronounced than positive ones. The symptoms and signs of schizophrenia in adolescents include thinking disorders, mood disorders, apathy. Some may be rude to their parents and relatives. Sometimes there are symptoms of depression. Some parents believe that this is teenage maximalism that will pass. However, under this mask, a serious mental disorder can be hidden. Positive symptoms appear in the form of:

• Brainy ideas. The teenager believes that he has many flaws in appearance. These ideas can develop into anorexia, harm to the body, and in rare cases, it can lead to suicide.
• hallucinations. Often manifested in sound forms. It seems to a teenager that the voices inside him criticize, condemn and scold.
• Passion for psychoactive substances. Sometimes a teenager can show a strong attention to drugs and alcohol, which will only harm his mind.

Treatment is the same as for adults. Consultation with a specialist and action is necessary. Diagnosis is similar to that of an adult. for treatment, a course of psychotherapy and medication is often prescribed. Separate work is also underway with parents so that they understand the reasons for the appearance of the diagnosis and know what kind of help the child needs.

International classification

The tenth revision of diseases since 2007 is the current generally accepted classification of diagnoses. Schizophrenia is assigned the F20 code according to ICD-10. The disease is a disorder characterized by a distortion of thinking, perception. According to modern data, the patient can retain his consciousness and intellect abilities, however, as the diagnosis develops, they may worsen.

Also, patients diagnosed with schizophrenia (ICD-10 code F20) think that their thoughts can be reflected and transmitted over distances. The disorder is characterized by manifestations of visual or auditory hallucinations, delusional states, erratic thoughts. Schizophrenia can occur both long-term and episodic. In some cases, symptoms of depression or mania are present.

Treatment of the diagnosis of schizophrenia

Scientists still consider this mental disorder the most mysterious and unexplored. However, it is possible to cure and reduce the symptoms of schizophrenia with the help of existing therapies. Diagnosis of schizophrenia includes the necessary examinations. If patients have attacks of hallucinations or delusions, then this must be treated in a hospital setting. Medications (antidepressants and neuroleptics) can successfully cope with various symptoms and manifestations of a mental disorder.

A person with such a diagnosis will need to constantly take medication and be under the supervision of doctors. And after the completed course of psychotherapeutic treatment and rehabilitation, the patient will be able to return to a normal lifestyle.

One of the most important parts of recovery is psychotherapy. Doctors give a complete description of the disease schizophrenia. Specialists also work with people and explain to them how to act during attacks, as well as what to do to reduce their number.

Psychotherapists conduct conversations with relatives of patients. After all, for effective treatment, patients must be provided with the necessary moral support and understanding. Group sessions are popular among specialists, where patients share their experiences and successes in recovery with each other. Such procedures are especially effective during the illness of sluggish schizophrenia. This has a positive effect on the emotional background of patients, which helps to reduce symptoms.

Thanks to the development of modern medicine, it is possible to allow patients with schizophrenia to live like ordinary people. However, a complete cure is not possible.