Features of schizophrenia: classification, symptoms, causes of development and treatment of the disorder

Schizophrenia is a psychotic personality disorder or group of disorders that is associated with disruption of thought processes and emotional reactions. Personality disorders are characterized by fundamental disturbances in thinking, perception, and reduced or inadequate affect. And auditory hallucinations, fantastic, paranoid delusions, disorganization of speech, thinking and impaired performance are the most common manifestations of the disease. The incidence of the disease is the same in men and women, however, women tend to have a late onset. The disease schizophrenia has a variety of symptoms, which in turn has given rise to debates about a single disease or a complex of individual syndromes. The very etymology of the word, which includes splitting of the mind, causes confusion, since the disease is mistaken for a split personality.

General information

Schizophrenia is a very serious mental disorder in which there is a significant distortion of the thoughts, actions, and emotions of the sick person.
The patient perceives reality in a special way and treats other people in the same way. Schizophrenia is defined as the most disabling chronic disease. Such patients face a number of problems when socializing in society, communicating with other people, and in close relationships. As the disease progresses, the person becomes very withdrawn and becomes afraid of many things. Symptoms of schizophrenia appear in the patient throughout his life, because the disease cannot be completely cured. However, with the right therapy, schizophrenia can be controlled.

Treatment

The basis of treatment for schizophrenia is psychopharmaceuticals, usually from the group of antipsychotics (neuroleptics). Today there are many drugs with different mechanisms of action. They stop hallucinations, mania (they either disappear or the person becomes indifferent to them), calm or revive motor functions, and counteract depressive, manic moods, and anxiety. Some medications can be purchased in depot form and are taken every few weeks.

Basal antipsychotic drugs

This group includes the following medicines:

• Levomepromazine (Tizercin);
• Clopenthixol, Cuclopenthixol (Cisordinol);
• Tyrodazine (Melleril);
• Chlorpromazine (Plegmomazine).

Side effects: severe sedation, drowsiness, decreased blood pressure.

Incisive antipsychotic drugs

This group includes:

• Prochlorazepine;
• Fluphenazine (Moditen);
• Perphenazine;
• Haloperidol;
• Flupenthixol (Fluanxol).

Side effects: extrapyramidal fever syndrome (tremor or restlessness may occur at certain times (temporarily).

Atypical antipsychotic drugs

Atypical antipsychotic drugs include the following:

• Clozapine (Leponex);
• Sulpride (Prosulpin);
• Risperidone;
• Olanzapine (Zyprexa);
• Tiapride;
• Sertindole;
• ziprasidone;
• Quetiapine.

Side effects: practically never happen.

Sometimes it is possible to prescribe appropriate antipsychotic drugs the first time, in some cases an effective remedy is determined on the 2nd attempt. If the disease does not respond to drug therapy, you can use Clozapine (Leponex, with blood count monitoring due to possible side effects on hematopoiesis), electroconvulsive therapy, or electric shock. Because schizophrenia impairs a person's functioning in major social areas, the patient needs additional psychological and social therapy.

Goal of treatment and rehabilitation:

• increasing the patient's resistance to stress;
• training in effective ways of communication, managing general requirements from the social environment;
• prevention of relapses.

Recommended Diet

You can treat and influence the course of schizophrenia with the help of nutrition. Recommended diet:

• exclude white sugar, sweets, use only molasses, honey;
• exclude white flour and products made from it (gluten is a known neurotoxin); limit other grains;
• reduce or eliminate red meat, milk, cheeses (except cottage cheese);
• drink 2 liters of clean, unsweetened, still water daily + 2 glasses of any herbal tea;
• Movement and swimming are recommended;
• include in your diet a lot of fresh fruits, vegetables, dried fruits, seeds, fish;
• to support pH, take 10 g of vitamin C per day;
• 5-8 tablets of B50 complex (strong form of B-complex);
• niacin – 1000-3000 mg per day;
• Fish oil and flaxseed oil are also recommended;
• Lugol's solution - 4 drops in drinking water, 1 drop - rub under the thyroid gland;
• Betaine HCL – 3 tablets with each meal;
• It is recommended to use a multimineral/vitamin complex.

Features of schizophrenia

According to the generally accepted definition, schizophrenia is a mental disorder in which a person loses the ability to distinguish between what is imagined and what is real. In many cases, people who show signs of schizophrenia behave quite strangely, and their behavior in some cases may even seem shocking. If a person experiences a sudden change in behavior and personality due to a loss of contact with reality, doctors talk about the manifestation of a psychotic episode .

When you compare the symptoms of schizophrenia among different people, they can vary greatly. Thus, some patients experience only one psychotic episode, other people with schizophrenia experience many similar episodes, but in between they can live a relatively full normal life. Symptoms of schizophrenia may worsen and become less noticeable during relapses of the disease and during remission.

The term “schizophrenia” refers to a whole complex of relatively diverse mental disorders. However, with different types of schizophrenia, people often exhibit similar symptoms.

Schizophrenia signs

All signs of schizophrenia are characterized by the International Classification of Diseases, 10th revision (ICD10). To diagnose the disease, it is important that at least one of these signs is noted.

The ICD10 classification identifies the following signs of schizophrenia: the sound of one’s own thoughts (echo of thoughts), openness of thoughts to others, taking away or putting in thoughts; delusions of influence, mastery, or passivity that specifically refer to the limbs or body, actions, thoughts, or sensations; delusional perception; hallucinatory voices that comment or discuss the sick person's behavior or other types of voices coming from various parts of the body; persistence of inadequate delusional ideas, manifested in absurdity or grandiosity in content.

Or two of the proposed signs should be noted - these are: interrupted speech, neologisms, sperrungs, persistent hallucinations with incompletely formed or labile delusions, but without pronounced affect; constant, overvalued obsessions, catatonic disorders (waxy flexibility, agitation, mutism, freezing, negativism, stupor); consistent and reliable changes in the general quality of behavior, which manifest themselves in loss of interests, aimlessness, and absorption in one’s own experiences; social autism; depression, apathy, poverty, social isolation, inappropriate emotional reactions, social unproductivity. It is very important for diagnosing schizophrenia that the symptoms persist for up to one month.

Types of schizophrenia

According to the symptoms that appear in the patient, several types of schizophrenia are distinguished.

The most common diagnosis in people is paranoid schizophrenia . Patients with paranoid schizophrenia have clear false beliefs, so-called delusional ideas , that they are being persecuted or are going to be punished. However, at the same time, such a person who develops paranoid schizophrenia thinks, speaks, and expresses his emotions quite normally.

With disorganized schizophrenia, a person often speaks and behaves in a generally incoherent, confusing manner; in addition, such patients suffer from anarthyria . Very often their behavior is characterized by indifference and despondency; sometimes they can behave quite inappropriately and even childishly. Due to the presence of a certain degree of disorganized behavior, people with these symptoms of schizophrenia are not always able to carry out normal daily activities. So, sometimes it is difficult for them to take a bath, clean, cook, etc.

In patients with catatonic schizophrenia, the most striking symptoms are of a physical nature. Such people are often in a motionless state and do not react at all to the world around them. They are characterized by stiffness , while they seem to freeze and have no desire to move. Sometimes such people exhibit specific body movements. For example, they can show grimaces and take very unusual poses. Some people with this form of schizophrenia often repeat words or phrases that another person has just said. Patients with catatonic schizophrenia are considered to be at high risk of malnutrition and malnutrition. In addition, such patients can cause bodily harm to themselves.

In undifferentiated schizophrenia, the symptoms are so vague that they are difficult to identify any other type of schizophrenia.

In patients suffering from residual schizophrenia , the disease syndromes are not as intense as in other forms. At the same time, a person often still has delusions, hallucinations and other symptoms of schizophrenia, but they manifest themselves much less clearly than at the time when schizophrenia was first diagnosed.

Types

There are 7 main types of schizophrenia - diagnoses. But experts point out that this classification is outdated and that a new division is needed. For example, the distribution of individuals with schizophrenic disorder according to the level and type of cognitive impairment.

However, while research is ongoing, the following types of disease continue to be used in psychiatry.

F 20.0 – paranoid

This is the most common type of schizophrenic psychosis. Usually older people tend to get sick with it (senile neurosis). The disease is characterized by positive symptoms - mania, hallucinations. This type of schizophrenia is called paranoid because of the paranoid manias present. The patient may feel threatened by other people, feel very jealous, feel persecuted, etc. The forecast is relatively optimistic.

F 20.1 – hebephrenic

Often detected in young people (about 20 years old). Manifestations include neglect of responsibilities, frequent use of vulgarisms, witty philosophizing, stupid jokes, strange thinking, strange whims. An adult woman or man often behaves like a teenager, typical of him is the behavior of an “absolutely all-knowing person.” Treatment of the disease is complex.

F 20.2 – catatonic

This is one of the most severe forms of schizophrenia. The catatonic form is relatively rare, with an incidence of about 1 percent of all cases of the disease. Movement disorders are typical for this type. It has 2 forms - stop and productive. With the stopping form, a person partially or completely stops moving. If you raise his hand, he will hold this position for a long time. Some schizophrenics may not move for many years, but they are unpredictable - they can suddenly do something. The reason for immobility is hallucinated voices prohibiting movement. The productive form is characterized by expressive, disorganized physical activity, repetition of certain movements, words or sentences.

F 20.3 – undifferentiated

Characterized by a combination of symptoms, does not belong to any of the classified types (for example, a combination of hebephrenic and catatonic types).

F 20.4 – post-schizophrenic depression

This is a depressive syndrome that occurs after the schizophrenic episode disappears.

F 20.5 – residual

This type is typically characterized by a chronic course of the disease, accompanied by panic attacks and increasing negative symptoms (slowing of psychomotor activity, emotional dullness, passivity, weakening of will and social contacts). This form does not respond well to treatment.

F 20.6 – simplex schizophrenia

This type can appear at the age of about 15 years, and is formed mainly by negative symptoms: emotional dullness, abulia, anhedonia, impaired thinking. In many cases, this type tends to develop into a chronic, sluggish form.

Causes of schizophrenia

To this day, the exact causes of schizophrenia in children and adults have not been established for certain. However, it is known for sure that schizophrenia is a disease, and its development has clear biological basis. Consequently, schizophrenia in a person is not at all due to improper upbringing or weakness of the person. Today, it is customary to identify several factors that become decisive in the development of schizophrenia.

First of all, one of the reasons why a patient develops schizophrenia is heredity . There is a clear tendency for the serial manifestation of schizophrenia in some families. That is, the genetic factor matters, and the possibility of developing schizophrenia, to a certain extent, can be transmitted to subsequent generations.

It has been proven that people with schizophrenia have an imbalance of certain chemicals in the brain. Thus, such patients are very sensitive or produce very large amounts of a brain chemical called dopamine . This substance is a neurotransmitter , its function is to facilitate the exchange of messages between nerve cells. If there is a certain imbalance of dopamine in the body, then the brain reacts differently to conventional stimulants, perceiving smells, sounds, and visual images in a special way. As a result, a person experiences both hallucinations and delusions.

Disorders in the human brain can also cause the development of schizophrenia. According to recent studies, disturbances in the structure of the brain, as well as its functions, have been found in patients with schizophrenia. But nevertheless, experts also take into account the fact that such disorders are not typical for all patients with schizophrenia. At the same time, they also occur in some healthy people.

The development of schizophrenia in a person can also be influenced by certain environmental factors. Thus, situations in which a person experiences severe stress , a viral infection , as well as too little expressed social interaction sometimes play the role of a trigger in the development of schizophrenia in a person who has inherited a genetic predisposition to this disease. Very often, the manifestation of schizophrenia is typical for people who experience very strong changes of both a hormonal and physical nature. Such changes are most typical for young people, as well as for teenagers.

Schizophrenia can manifest itself in almost every person, regardless of his age, race, or standard of living. Most often, the first signs of schizophrenia appear in people during adolescence, as well as in young people who are already twenty years old. Both women and men suffer from schizophrenia equally often, but in women it manifests itself mainly later - at the age of 20-30, and in men - in adolescence. Schizophrenia in children under five years of age is diagnosed in rare cases.

Variants of the course of the disease

Schizophrenia can occur in several forms:

• continuous;
• paroxysmal;
• paroxysmal-progressive or fur coat-like.

The continuously ongoing form of the disease is the richest in symptoms. During its course, both negative and positive signs are shared. This form of the disease is characterized by a continuous, progressive course. In her clinical picture, periods of symptomatic outbreaks alternate with calmer phases, but in this case there is no talk of remission.

The continuous form of the disorder is expressed in 3 variants:

• low-grade schizophrenia;
• paranoid schizophrenia;
• malignant schizophrenia.

Sluggish schizophrenia is considered the most favorable type of disorder. During its course, negative symptoms predominate and in most cases do not lead to a deep disintegration of the personality. Productive symptoms include phobias, obsessive thoughts, hysteria, and depersonalization. It manifests itself in the form of a calm, mildly expressed constant course, with periodically occurring attack periods.

Phobias and obsessions very often form the basis of a sluggish form of schizophrenia. The former can be of a varied nature:

• fear of moving in transport;
• exposure to external hazardous factors - poisons, chemically hazardous substances, pathogens, piercing objects;
• fear of helplessness;
• fear of madness.

Anxiety in schizophrenia is a frequent accompaniment of the disorder, leading to the formation of anxious-phobic states. These are, first of all, panic attacks, characterized by specificity and illogical manifestations. Among them, a generalized fear of harming oneself and others dominates. The patient has a concentrated panic fear that he might kill someone, steal someone else's child, or jump out of a window. Fear is exaggerated, accompanied by vivid images of the imagination, which further complicates the situation.

Panic attacks are also accompanied by somatovegetative disorders in the form of unusual sensations in the body, the appearance of severe weakness, and incorrect perception of the structure of one’s body. Inappropriate sensations arise such as “someone is squeezing the heart inside into a fist”, “a corrosive mixture has been poured into the stomach.” On this basis, phobias such as fear of developing a heart attack or stroke are produced.

A 38-year-old woman was walking down the street and suddenly felt a strong blow to her head. After this, a feeling of compression was formed that moved in the brain. She was afraid that she was about to be paralyzed: she seemed numb, she couldn’t even say anything. It seemed to her that she was being divided into two parts. At the same time, she was conscious, the ability to move was preserved, but she did not feel her movements. Soon it was all over.

Upon arrival at the psychiatric hospital, it turned out that the patient was suffering from an obsessive conspiracy thought: all the people she meets on the street, her colleagues at work, are watching her and constantly discussing her.

In the hospital, the patient had a headache all the time. The sensations were different: sometimes it was stuffed with cotton wool, sometimes only one half of the brain was working, it was pulsating and protruding from the skull. She was lethargic, gloomy, constantly lying down, all the time focusing on her feelings. She believed that she had brain cancer, but tests disproved this theory. She showed increased concern about her health. She was rude and mocked the staff.

In addition to phobias, the patient develops obsessions. Among them is the desire for cleanliness and absolute order. An invincible desire appears to put everything in its place, but not in the usual form, but with a manic absolute. If towels are folded in a closet, then this is done as if under a ruler, and when one edge gets out of line, the patient strives to quickly fix it. Everything in his house is arranged with amazing precision, sorted by color and size. And most importantly: it is unacceptable to violate the established order.

Other pathological thoughts are inspired by the cleanliness of one's clothes and body. A person constantly thinks that his clothes are dirty, although there is no reason for this.

Another common group of obsessions is constant doubts. The patient torments himself with thoughts that he is seriously ill. Constant doubts creep into his mind about the actions he has taken, some of the most common: did I turn off the gas, the iron, or locked the apartment. Gradually such doubts become more widespread. They arise in connection with events that have not yet happened or acquire a completely pathological character: the patient begins to doubt whether he has killed someone or whether he is involved in some illegal acts. Gradually the obsessions become more and more ridiculous.

Then fears and obsessions lose their primacy, being replaced by rituals, they come to the fore in the picture of the disorder. If a person is concerned about his health, he regularly visits doctors. In the case of obsessive cleanliness, he systematically “brings” his clothes to shine: cleanses imaginary dirt.

Ritual actions in the process of their development turn into stereotypical, subconscious repetitions. During the manifestation of the disorder, the patient may harm himself: pulling out hair, piercing the skin, squeezing in the eyes. These features distinguish this form of schizophrenia from obsessive-compulsive disorder.

A little more about low-grade schizophrenia

Another sign of low-grade schizophrenia is depersonalization. It manifests itself as a total emotional breakdown, that is, it affects different aspects of the psyche. The patient loses interest in life, he becomes uninitiative, inactive, passive in his actions and desires.

At the onset of the disease, one may notice hypertrophy and instability of individual feelings and emotions. For example, mood lability, exacerbation of stress reactions, imagination.

A significant symptom is a change in self-perception. The patient notes that he is losing flexibility of thinking, the ability to perceive the world around him fully - it seems somehow unreal, dull. A person may not recognize himself in the mirror.

Attacks of the disease are accompanied by anxious-apathetic depression or panic attacks. In a more favorable period, low mood and dysphoria are observed.

In the prime of the disease, a phenomenon called painful anesthesia appears. This is an emotional vacuum in which a person loses the ability to feel and react to what is happening with the range of emotions given to us by nature. The movie he watched, the story he heard, his loved ones are equally indifferent to him. He feels neither pleasure, nor fear, nor empathy. The world stopped, froze.

There is a gap between the human “I” and reality. The patient loses contact with the past, forgets who he was. The life around him is not interested. He does not understand the relationships between people, what they are needed for.

The culmination of the disease is defective depersonalization - the expression and understanding of one's inferiority, regression of feelings, emotional dullness. Detachment from people is associated with the loss of the ability to establish relationships with another person and make new acquaintances.

Sluggish schizophrenia can develop against the background of psychopathy, most often of the hysteroid or schizoid type. Hysterical VS is expressed in symptoms of hysteria, only exaggerated several times. Hysterical attacks are rude and feigned, with pronounced demonstrativeness and affectation.

Hysterical psychosis, in some cases lasting up to 6 months, is accompanied by a change in consciousness. A person experiences imaginary hallucinations. Over time, they transform into pseudohallucinations - a more persistent and severe form. Excitement gives way to stupor.

Gradually, pathological traits such as adventurism, deceit, meanness, etc. stabilize in the patient’s personality, but at the same time, demonstrativeness and loudness of behavior go away. The appearance of the patients is characteristic: they often turn into tramps, but at the same time they look bright, wearing fancy clothes and an overabundance of cosmetics for women. Such people immediately catch your eye.

The development of the schizoid type of disorder can be traced using the following example. Boy 15 years old. Before the illness he had positive characteristics. Diligent, disciplined, diligent, serious. I played sports and studied well. I was interested in chemistry. Was closed. I didn’t make close friends with anyone, but my relationships with my classmates were smooth.

Changes began to manifest themselves with emotional coldness, especially towards the mother. He began to treat her rudely and shouted at her. He responded to her wishes and feelings with indifference. Stopped doing housework. He locked himself in his room and performed some experiments. Confused day with night.

It became difficult to wake up in the morning and stopped going to school. He completely isolated himself from his classmates and did not leave the house. Previously unacceptable anger, rudeness, and grumpiness developed in his character.

Over time, I stopped taking care of myself. He didn’t brush his teeth, didn’t wash, walked around in dirty underwear. He rejected all his mother’s attempts to talk to him. He demanded that she buy him equipment for his experiments.

The negative symptoms of the sluggish form of the disorder are most widely manifested in symptom-poor schizophrenia, although according to modern nomenclature this form is considered a subtype of schizotypal disorder.

Among its main symptoms are progressive autism and detachment from others. Emotional decline is manifested by inhibition of drives and a decrease in sensory reactions. Other signs include physical inactivity, lethargy, depression of mental and physical activity, and lack of motivation to act.

Mood disorders are usually expressed by depression and hypochondria. Complete immobilization or stupor is not observed, but actions become slow and clumsy. Speech is monotonous.

Such patients are able to take care of themselves independently and even do simple work, but are not adapted to living alone. Requires supervision.

Malignant schizophrenia

The malignant form of continuously ongoing schizophrenia is characterized by rapid progression of the pathological process. Over 3–5 years, irreversible changes in the psyche occur, leading to the formation of a schizophrenic defect.

It appears at a young age, usually before the age of 20, and accounts for 8% of all cases of the disease.

Malignant or grossly progressive schizophrenia can occur in 3 forms:

• simple schizophrenia;
• catatonic;
• hebephrenic.

In the latent period of grossly progressive schizophrenia, schizoid features come to the fore. This is an emotional stupor, when emotions become dull and the sensory response becomes monotonous, without impressions and expressiveness.

Activity and ability to work decrease, interest in previously significant things is lost. The person is apathetic, exhausted. There are some oddities in behavior. Difficulties in communication arise.

During the heyday of the disease, symptoms of one of the types of malignant schizophrenia dominate.

In the simple form, the patient is accompanied by negative signs. Productive symptoms are not typical for simple schizophrenia.

The main symptoms are apathy, lack of will and blurred emotional reactions. Ridiculous hobbies appear in the form of collecting useless things and designing unnecessary inventions.

A typical phenomenon is metaphysical intoxication. The patient shows interest in psychological, philosophical, and theological topics. He begins to analyze everything that happens in the world, but in the form of fruitless philosophizing, detached from reality, and not subject to any criticism. It resists the logic we are accustomed to. As a result, it turns out that the person spews illogical conclusions. They are vague and unstable, but the patient is confident that they are right and does not try to convince anyone or win anyone over to his side.

His statements are filled with terms, scientific expressions, abstract concepts, but they are not connected in meaning. For example, to the question: what is a head, the patient answers: it is a part of the body without which it is simply impossible to live. It is possible without an arm or leg, but without a head it is undesirable. This is the power of the body, in it lies the brain - the brain of the body.

In adolescents, who more often than others struggle with a simple form of schizophrenia, the disease can manifest itself as an inversion of character traits. So, a calm, obedient, good-natured teenager suddenly begins to show aggressiveness and cruelty. He is rude, rude, cold, indifferent, and aggressive towards loved ones.

Such patients are inactive and can lie on the couch all day. Children skip school, become members of gangs, and run away from home. They ignore basic rules of self-care.

Simple schizophrenia quite quickly causes the development of complete lack of will and apathy, loss of vital energy, and impaired speech.

A patient with hebephrenic schizophrenia can be characterized as having relapsed into childhood. The name of the disease comes from the name of the ancient Greek goddess of youth, Hebe. An adult behaves like a child. Fooling around, running, jumping, making faces.

The behavior of such patients is pretentious and unpredictable, characterized by spontaneity and aimlessness. Patients are having fun, giggling, grimacing, and taking unnatural poses. Causeless fun quickly gives way to crying and depressed mood.

The activity is characterized by primitivism. Thus, a teenager suffering from hebephrenic schizophrenia, tired of waiting for the restroom to be free, shit in his shoe. And then he tied him to the lamp.

Speech is incoherent and devoid of logic. Patients use foul language or, on the contrary, lisp.

Such people cause fear and hostility among those around them. When asked to stop this behavior, patients increase its intensity or show aggression.

The disease progresses quickly, and at the end of the process, complete indifference and inactivity sets in. A person cannot cope with basic tasks and serve himself.

Catatonic schizophrenia manifests itself by alternating phases of stupor and excitement. Catatonic stupor is characterized by freezing in one position, often of an absurd nature. Such patients are characterized by waxy flexibility - they retain any position given to them. Catalepsy occurs when a part of the body remains in one position. For example, if you raise the patient's hand and then release it, it will freeze in the raised position.

In this state, a person isolates himself from others. Does not respond to speech addressed to him, does not respond to any impulses.

Stupor suddenly gives way to excitement. Stereotyped movements are noted; patients can copy the actions and speech of other people. They run, dance, have fun, take mannered poses. Mood is subject to sudden changes: from low, depressed to high, sometimes aggressive. Active and paradoxical negativism is observed when a person either refuses to fulfill a request directed to him or does the opposite.

The clinical picture is supplemented by the phenomena of depersonalization and derealization, delusions and hallucinations.

Here is a description of how a patient behaved in a psychiatric hospital at the moment of catatonic excitement: “He constantly talks and swears. Aggressive towards patients and staff. Lying on the bed, he knocks on it with his feet, then jumps up and hits his forehead on the floor. He runs out of the room, banging on all the doors. Not sleeping. Running up to the patients, he hits them on the back with his fist. He cannot sit still and falls to the floor. She listens to something, says that she is being followed, threatens to shoot someone. She claims that everything around is saturated with current, she will be destroyed.”

Catatonic excitement is accompanied by an oneiric state, when patients become direct participants in fantastic pictures of their imagination: the end of the world, the arrival of aliens, the invasion of dinosaurs. It happens that the process is reinforced by an increase in temperature, the appearance of bruises on the body, and symptoms of exhaustion.

Upon recovery from the state, the patient talks about his fantastic adventure in bright colors.

Paroxysmal schizophrenia

This form of the disease, in contrast to the continuously ongoing one, is distinguished by the occurrence of schizophrenic attacks that develop within 2 days and last a couple of weeks.

Before the attack begins, the patient feels inexplicable anxiety and confusion. There is a feeling that he does not understand the essence of what is happening around him. Sleep is disturbed, the person suffers from insomnia. Mood instability is also a typical symptom. Joy and fun suddenly give way to crying and apathy.

The attacking period is characterized by the appearance of hallucinations and delusional ideas. Hallucinatory decoys are often auditory: voices typical of schizophrenia, threatening, commenting, guiding. There are also olfactory hallucinations with an interesting characteristic: a yellow smell, the smell of an earthen mound.

Delusional ideas are not persistent and constant. They are episodic and situational. For example, if a doctor listens to a patient with a phonendoscope, then he gets the idea that the doctor is eavesdropping on his thoughts.

Delusions of staging are common. A patient, entering a store and seeing a crowd of people in it, mistakes it for a secret society.

Usually the attack goes away even without treatment. On average, the interictal period is up to 3 years. But different variants of the course of the disease are possible, in which the frequency of relapses and their intensity changes.

A favorable factor that helps reduce the frequency of attacks is the patient’s age. A milder course is observed in patients over 30 years of age. In this case, the cause of exacerbation becomes provoking factors, psychogenic or somatic. Manifestations of the disease are mild in nature, and periods of remission last more than three years. There is a possibility of forming longer remissions.

Symptoms of schizophrenia

With schizophrenia, a person exhibits certain signs of the disease that make it possible to suspect the development of this disease. Signs of schizophrenia are expressed by changes in a person's abilities and personality, and they may exhibit different types of behavior at different times. As a rule, at the first manifestations of schizophrenia, the symptoms of the disease are very pronounced, and they appear unexpectedly.

Most often, the symptoms of schizophrenia are divided into three different groups. Thus, disorganized symptoms , positive symptoms and negative symptoms .

When positive symptoms , the definition of “positive” does not always mean “good.” Such symptoms are obvious in patients with schizophrenia. Accordingly, they are absent in a healthy person. Another name for such symptoms is psychotic symptoms. This category includes the following signs of schizophrenia: - delusions , which are strange beliefs that have no real basis. At the same time, the patient never gives up such ideas, even if he is given clear facts that refute such an idea. Thus, very often patients with schizophrenia have delusional ideas that he is, for example, God or Satan, that other people hear all his thoughts, that someone deliberately puts certain beliefs in his head. — hallucinations are sensations of a sick person that are not actually real. A patient with schizophrenia may look at certain objects that do not actually exist, hear in his head, smell some smells that do not exist in reality. It may also seem to a person that someone is touching him, although in reality this is not happening. Experts say that the most common hallucinations in patients with schizophrenia are vocal hallucinations. The voices that a sick person hears can command his behavior, comment on what the patient is doing, etc.

The essence of disorganized symptoms is that a person cannot think clearly enough and, accordingly, an adequate response is impossible. So, an example of such disorganized symptoms can be the pronunciation of completely meaningless phrases or words, which, accordingly, significantly complicates the communication of a person with schizophrenia with other people. During a conversation, the patient can very abruptly move from one thought to another, and he experiences slow movements. Another symptom of this type is the inability to make any decisions. A person in such a state can write a lot, but his letter will have no meaning. He often loses things and forgets where they are. Also a disorganized symptom is the frequent repetition of gestures or movements - for example, the patient walks in a circle for a long time, takes meaningless steps. It is very difficult for him to understand simple sounds, images, feelings that occur in everyday life.

When we talk about negative symptoms , we mean the absence of norms of usual behavior in a patient with schizophrenia. Among the negative symptoms, it should be noted that the patient has no emotions and adequate mood appropriate to the situation. So, a person may start crying instead of laughing at jokes. An important symptom is the isolation of the patient both from family and friends, and from social life and activities in general. A person lacks motivation, loses satisfaction in life and interest in life, and becomes less energetic. Accordingly, negative changes are observed externally: the patient does not follow hygiene standards and does not take care of himself. A person in this state has many problems both in the work sphere and in other activities. His mood changes very sharply - a person who was happy just a few seconds ago can suddenly become upset for no reason. Also, as a negative symptom of schizophrenia, the patient exhibits catatonia. In this state, the patient seems to freeze and remain motionless in the same position for a long period.

How does schizophrenia manifest itself in women in various forms?

Sluggish

Symptoms and signs of schizophrenia in women are mild . They are smoothed out or weakly expressed, appearing episodically in the form of apathy, depression, outbursts of aggression and irritability, and indifference to family members. After the attacks pass, a long stage of stabilization begins, when the patient behaves like an ordinary, healthy person.

Paranoid

Expressed in the presence of auditory hallucinations and persecution mania. The voices in a woman’s head constantly talk to her, conducting meaningful dialogue. Often a woman is in constant harmony with her inner world. Delusional ideas of persecution make the patient suspicious and irritable. She “imagines” surveillance of her person everywhere, even from TV screens.

Manic-depressive

This form of the disease is characterized by a constant change of two phases - depression and mania with a delusional or hallucinogenic component. Symptoms of schizophrenia manifest themselves in an unbalanced emotional background. A woman can cry with emotion, and a minute later swear furiously. Patients get tired very quickly and feel chronic fatigue.

Neurosis-like

One of the mildest forms of schizophrenia. It manifests itself in the presence of phobias. Girls and women are critical of their appearance , considering themselves ugly, fat or too thin, useless to anyone. They withdraw into themselves, isolate themselves from society, or, conversely, begin to behave provocatively and vulgarly.

Alcoholic

This type of schizophrenia occurs in women due to prolonged alcohol abuse. Women become addicted faster than men. In a state of drunken stupor, they behave aggressively - they scream loudly and start fighting. Patients experience increased anxiety and complain of auditory and tactile hallucinations.

Hebephrenic

Expressed in immaturity and foolishness. The patient's actions are similar to the pranks of a child. She shows inappropriate grimaces, can giggle for no reason, her voice becomes cutesy, unnatural, and her manner of communication becomes feigned and theatrical. At the same time, the woman stops taking care of her appearance - she doesn’t wash her face, doesn’t comb her hair, combines things that don’t match each other, and wears them for weeks. This form of mental disorder is the least responsive to drug therapy, so the prognosis for treatment in most cases is unfavorable.

Senile

The main symptoms of schizophrenia in older women are associated with impaired short-term memory. They do not remember the details of the past day, but can accurately reproduce stories from twenty years ago. Illusions become a feature of this form of the disease. Old women invent events for themselves, sincerely believing that they actually happened to them.

Diagnosis of schizophrenia

Diagnosis of schizophrenia is carried out in those patients who have corresponding symptoms. The specialist conducts a clinical examination. There are currently no special tests for diagnosing schizophrenia. Consequently, the doctor uses a variety of research techniques, for example, radiography. Laboratory blood tests are also carried out in order to completely exclude the presence of a physical illness in a person that provokes such symptoms. If there are no physical causes that provoke such symptoms, the patient is referred for further examination by a psychiatrist or psychologist. To assess the patient’s condition, specialized specialists use various assessment programs, psychological tests, and also conduct interviews specially designed for such diagnostics.

To make a diagnosis of schizophrenia, the doctor also evaluates the duration of symptoms. So, if a person has the symptoms described above for at least six months, he is diagnosed with schizophrenia. It is very important that the diagnosis is carried out by an experienced specialist and that this process is approached in a multi-faceted way, as there is a possibility of an incorrect diagnosis.

Second period of illness

The second stage of schizophrenia leads to the fact that the patient is aware of the presence of pathology, or the symptoms progress. In the first option, early seeking medical help allows you to control the course of the disease and achieve a full recovery. Schizophrenia cannot disappear on its own.

In the absence of therapy, a person quickly adapts to existing symptoms. He begins to take into account existing delusions and hallucinations when making decisions and adjusts his behavior. In the absence of therapy, clinical signs develop and the following symptoms occur:

• complete apathy with a lack of emotional reaction to current events and loved ones;
• the emergence of complex delusional systems that take into account various spheres of human life;
• dementia typical of older people;
• disturbances in motor activity with its depression or constant motor agitation.

Symptoms of schizophrenia in the second phase become chronic. Contact with other people may disappear completely. Patients develop somatic disorders: headaches, disorders of the digestive system, general fatigue, etc. When talking with the patient, confused speech, sharp transitions between thoughts and incomplete sentences are noted.

Prevention of schizophrenia

At this time, there are no known methods to prevent the manifestation of schizophrenia. But with the help of early diagnosis and immediate proper treatment, the course of the disease can be alleviated by reducing the number of relapses. Adequate therapy is the key to the fact that a person will subsequently be able to lead a full life. It is also important to take into account the fact that those people who have already had manifestations of schizophrenia in their family should be especially attentive. Heredity plays an important role in this case, so it is important for such people to promptly detect the appearance of the previously described symptoms.

Diagnostics

To make a diagnosis, as a rule, no specific tests are required. The psychiatrist examines the patient, talks with him, and assesses behavioral habits. Relatives of the patient can express their pain to the doctor, describing symptoms that may not be present at the moment. Sometimes the Luscher test can be used to make a presumptive diagnosis.

The Luscher test for schizophrenia is based on the study of the patient's color perception. He is offered photos with different flowers and given the opportunity to identify them several times in order of the most attractive. Using this method, you can assess the mood, emotional state and stable personality traits of the patient.

Schizophrenia in children

When diagnosing schizophrenia in children, it should be taken into account that behavior that is adequate for children of a certain age may be abnormal for another age. Thus, parents may suspect the manifestation of schizophrenia in children if a child who is already seven years old does not show friendliness towards other people, is afraid of snakes, spiders and other creatures that are scary for him, which are not actually near him. Parents should also be wary of the fact that the baby hears voices. All this may indicate the development of a mental illness, in particular schizophrenia. Children with schizophrenia can have a number of difficulties in everyday life; treatment of schizophrenia in children is also a more difficult process than in adults. It is very important, immediately after parents suspect possible problems with the child’s psyche, to immediately contact specialists, since therapy for schizophrenia in children should be carried out without delay. However, according to existing statistics, schizophrenia in children is currently quite rare.

Reasons for the development of the disease

The most common cause of schizophrenia is considered to be a hereditary factor . If both parents suffer from this disease in a family, the possibility of their child acquiring this mental disorder is 50%. Children are at risk, even if this diagnosis occurred in the family several generations ago.

Signs of schizophrenia in young women are observed against the background of a sharp change in hormonal levels - during pregnancy and after childbirth. Other reasons may be:

• viral infections suffered during pregnancy;
• birth, traumatic brain, psychological trauma;
• long-term use of alcoholic beverages and drugs;
• cases of physical or sexual violence that occurred in childhood.

List of sources

• Kotsyubinsky A. P., Sheinina N. S., Mazo G. E. Autochthonous nonpsychotic disorders / Ed. A. P. Kotsyubinsky. - St. Petersburg: SpetsLit, 2015;
• Kholmogorova A. B. Psychotherapy for schizophrenia: models, trends // Moscow Psychotherapeutic Journal. - 1993. - No. 2;
• Kurek N.S. Deficit of mental activity, personality passivity and illness. - M., 1996;
• Psychiatric care for patients with schizophrenia: Clinical manual / Ed. V.N. Krasnov, I.Ya. Gurovich, S.N. Mosolova 2006.

Main signs of the disease

There are many different forms and varieties of schizophrenia. It can be senile or develop from birth. However, each of them has the main, most common symptoms, characteristic of both men and women, and for an infant and an elderly person.

Initial signs

The symptoms of the disease can be quite varied, but most often the symptoms of the disease are quite easy to notice. The initial stage of the disease can be expressed by causeless anger and aggressiveness towards loved ones and relatives, lack of interest and feelings for relatives, cooling of family relationships, and the emergence of delusional ideas and thoughts. A general sign of incipient schizophrenia can be expressed in the loss of interests or hobbies that were previously characteristic of the sick person.

In some cases, the onset of the disease is manifested by obsessive fears, thoughts and actions. One of the initial symptoms is also auditory hallucinations, which manifest themselves in the form of a voice in the head giving orders to the patient.

External symptoms of the disease

Often the development of such a disease is characterized by a weakening of various instinctive feelings. Such people may not feel hungry for quite a long time. Lack of appetite is due to loss of complete interest in food. Also, people with schizophrenia are easily distinguished by their sloppiness. A sick person is absolutely not interested in what he looks like or his home. He stops bathing and cutting his hair, washing his clothes, and tidying up his home. With developing schizophrenia, it is difficult not to pay attention to the external somatic signs of the disease:

• Patients often have severe headaches;
• feeling of heaviness in the back of the head and temples;
• headache causes a feeling of squeezing and burning in the head;
• general weakness of the body;
• restless sleep, insomnia.

The early stages of the disease are often accompanied by sudden and involuntary movements, usually not characteristic of humans. This may manifest itself in overly active facial expressions, slow blinking, twitching of the corners of the mouth, twitching and tremor of the limbs.

What is schizophrenia

The name of the disease comes from two ancient Greek words: “σχίζω”, which means “splitting or bifurcation” and “φρήν”, which can be translated as “reason, mind, thinking”. The etymology of the name has given rise to a lot of controversy and created a lot of confusion: schizophrenia is often confused with another mental illness - split personality.

According to statistics, this disease affects four to six people out of every thousand. Moreover, both men and women are equally susceptible to developing the disease, although male schizophrenia manifests itself at an earlier age than female schizophrenia. This mental disorder is most often diagnosed between the ages of sixteen and thirty. But this does not mean that it is impossible to get sick at a different age. The statistics speak for themselves. The peak age is considered to be twenty-six to thirty-two years for women and twenty to twenty-eight years for men. Much less common is childhood schizophrenia, as well as late or senile schizophrenia, which develops in old age.

Often, such a mental illness develops and proceeds at a slow pace, so that the patient does not even suspect that he has any mental disorder. But there are cases when schizophrenia occurs suddenly and progresses quite quickly. Therefore, it is necessary to know exactly the initial symptoms of the disease in order to recognize them in a timely manner and seek medical help.

The many forms and types of the disease, as well as a significant number of different symptoms, have raised doubts that schizophrenia is a separate disease, and many scientists believe that such a diagnosis implies a large number of separate syndromes.

Most patients with this diagnosis do not pose a danger to people around them, although in some cases they may show inexplicable aggression and cruelty. Such people live like everyone else: with family, on their own, or in group homes. In rare cases, with a severe course of the disease, forced hospitalization of the patient is possible, but the frequency and duration of the patient’s stay in such an institution is limited and the person, with qualified treatment, soon returns to normal life.

Diseases with manic syndrome

Manic changes in the psyche are observed in three conditions - paranoid schizophrenia, bipolar affective disorder and schizoaffective disorder. Men and women with similar pathologies experience alternating periods of emotional depression and indifference with periods of hyperactivity and excitement. As a rule, between them there are short phases of remission, during which pathological symptoms are not detected. Such similarity of the two conditions makes it difficult to carry out differential diagnosis and prescribe effective therapy.

Doctors identify a number of characteristic signs of paranoid “manic” schizophrenia, which are always absent in bipolar affective disorder:

• the leading symptom is delusion, characterized by mania of persecution and threat to life;
• multiple hallucinations associated with vision and hearing;
• manifestations of autism in the form of emotional “scarcity” and indifference to others;
• catatonic phenomena - the patient can freeze in one position for an indefinite period of time;
• absence of speech while maintaining the function of the speech apparatus.

Based on this, schizophrenia is a disease characterized by changes in thinking processes, which is reflected in the appearance of delusions and hallucinations of varying severity. An important feature is that a person is not aware of the irrationality of his train of thought, since the delusional system is formed over the years, gradually affecting more and more new areas of life.

Bipolar affective disorder causes changes in mood, which leads to behavioral abnormalities. The disease occurs in waves: periods of depression and hyperactivity follow each other at various intervals. Delirium is not typical, however, pathology of thinking is possible, but delirium is weakly expressed and quickly disappears.

In schizoaffective disorder, both thinking and mood change. The condition develops mainly after intoxication with alcohol, narcotic and toxic drugs, as well as after severe mental trauma and prolonged stress.

Negative and positive symptoms of the disease

All symptoms of schizophrenia are divided into negative, positive, otherwise productive, and cognitive. To make a correct diagnosis, clinical negative signs are most characteristic. Many of them have already been given above with full descriptions. Therefore, now let’s briefly look at each group of symptoms.

Negative signs are certain characteristics and personality traits that the patient loses as the disease spreads. These include:

• apathy – emotional rigidity, indifference, complete detachment from everything;
• autism – isolation of the patient, withdrawal into his inner world, degradation in social terms;
• ambivalence - duality, splitting in the emotional sphere, the feeling of two opposing feelings towards the same object;
• abulia – a complete or partial violation of the will, which is characterized by a significant drop in activity, up to complete inaction;
• thinking disorders - paralogicality, fragmented thinking, symbolism and reasoning.

Positive symptoms are secondary signs of the disease that arose during the development of the disease. These include:

• delusional ideas;
• hallucinations;
• disorganization of speech and thinking;
• depersonalization and derealization.

Cognitive symptoms include depression accompanied by suicidal tendencies.

Lifespan

Life expectancy with this disease is eighty to eighty-five percent of the average. Women with this diagnosis live longer than men, and patients die mainly during suicide attempts. This is greatly influenced by long-term use of antipsychotic drugs and antipsychotics, as this can lead to cardiovascular diseases and pulmonary pathologies. Poor diet, lack of physical activity and smoking also contribute to the statistics.

Main symptoms

Practical psychiatry identifies three groups of symptoms of schizophrenia.

1. Positive syndromes:

• hallucinations;
• rave;
• inhibition of thinking: illogicality and confusion of thoughts, inability to complete a sentence, forgetfulness (“Why did I go there? Why did I take this object?”);
• derealization - the absence of boundaries between reality and fiction.

Let's try to clearly explain who a schizophrenic is, how to recognize him, in the presence of the last, most difficult to define syndrome. An example would be a person who is unable to personalize their own personality. He considers himself “absorbed by the world,” denies relatives and, on the contrary, insists on kinship with complete strangers.

2. Negative syndromes:

• emotional coldness (frozen facial expressions, monotony of speech);
• lethargy (difficulty maintaining a conversation, inability to make quick decisions);
• low concentration;
• loss of interest in life, replacing reality with obsessions;
• asociality: it is difficult for a person to make acquaintances, he has poor contact with others, and subsequently stops communicating even with loved ones.

3. Cognitive syndromes also help us understand who a schizophrenic is. Symptoms of cognitive dysfunction will help to draw a prototype of such a patient in a form sufficient for perception. Here we are talking about various disorders of attention, thinking and memory. The patient's speech is distorted: conversations become abstract, vocabulary becomes poorer. A person’s daily life is changing: social, domestic and professional responsibilities become difficult to fulfill.

Diagnostic measures

Identification of diseases united by the term “manic schizophrenia” is very difficult for doctors, since the criteria for making a diagnosis are not always clear. The main approach involves conducting a conversation with both the patient himself and his close relatives. During the conversation, the psychiatrist pays attention to the person’s thinking, his behavior, the adequacy of answers to questions and the presence of signs of delusional ideas. It is important to understand that not all patients actively share their thoughts about being harassed by others, as they may perceive the doctor as an “enemy.”

When making a diagnosis, the criteria for identifying schizophrenia are taken into account - the patient must have at least one criterion of the first level and two or more criteria of the second level, according to the ICD-10 classification. Delusions, delusional perception, the sensation of the sound of one’s own thoughts and auditory hallucinations are the criteria of the first level. Second level criteria: catatonia (periodic freezing in one position), visual or tactile hallucinations, behavioral changes and other mental disorders. The duration of observation of symptoms to classify them as any type of criteria is 4 weeks or more.

To study the emotional sphere and mental status, specially developed scales and tests are used. The most commonly used are the Luscher test, the PANNS scale, the Leary test and other methods. Such testing makes it possible to indirectly assess various cognitive skills and emotional characteristics of the patient, which is necessary to identify the severity of changes and confirm the diagnosis.

If organic pathology of the brain is suspected: the growth of a malignant tumor, changes after a traumatic brain injury or a disturbance in the blood supply to the central nervous system, instrumental research methods are carried out. Magnetic resonance imaging and angiography of the vessels of the head and neck with Dopplerometry are the most informative. Only the attending physician should interpret any data obtained during diagnosis.

Thinking and perception of a schizophrenic

Patients with schizophrenia often have a distorted perception of reality. Such people often deny obvious things and facts and give completely ordinary events a certain special meaning. Most often this is expressed in delusional ideas that the potential patient considers brilliant. Typical delusions in schizophrenia are:

• delusions of persecution;
• megalomania;
• delusion of perception;
• delirium of jealousy;
• loss of control.

With such an illness, fragmented and torn thinking is also observed. Most often this is reflected in the speech of patients. It is very difficult for such people to concentrate on the subject of conversation; they jump from topic to topic, answer questions inappropriately, speak incoherently and illogically. The thinking of schizophrenics is chaotic and completely lacks logic. Sick people find it difficult to connect even two simple facts.

Disease detection tests

Currently, there are many different tests with which you can test yourself and find out about the possible presence of this disease. The simplest and fastest test for identifying schizophrenia is a mask test.

Everyone has a very good idea of ​​a theatrical mask. It has two sides: a convex side, with which it appears to others, and a concave side, which is worn directly on the face. The test asks you to carefully look at a moving mask and answer two questions:

1. Is the mask convex on only one side?
2. Does the mask rotate in one direction or both?

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When answering questions, it is important to discard logic and common sense and be guided only by feelings.

Of course, the mask only rotates in one direction, and only has a bulge on one side. However, it is the correct answer to both questions that makes it possible to assume that a person has a tendency to develop and develop schizophrenia.

The brain of a healthy person tries to complete the picture as it should really be, because a priori the face cannot be concave. The brain of a schizophrenic, in turn, works somewhat differently. He is unable to analyze the image and complete it to normal. Thus, the sick person sees the picture exactly as it really is.

The famous Rorschach test can also help identify schizophrenia - a test with pictures that depict ten black-and-white and color blots in which each person sees different images. They are presented in a strictly defined order. Based on these answers, an experienced psychiatrist builds a certain picture of the disease.

Another interesting test for identifying schizophrenia is the Luscher test, in which the patient distributes colored cards in order of their most preferred colors at the moment. This is a short version of the test. The original represents seventy-three colors, grouped into different groups, from which it is necessary to select only those colors that most attract the patient at the present time. Schizophrenics, for the most part, prefer yellow colors, confuse shades or are generally indifferent to them. And also most often they have a negative attitude towards the colors red and black.

However, one should not speak with certainty about the presence of a disease based only on tests; an accurate diagnosis should only be carried out by an experienced psychiatrist.

Treatment of the disease

Although schizophrenia is an incurable disease, with proper and timely treatment, complete remission can occur and patients can live a normal life.

Treatment of this disease involves complex therapy, including the following methods:

1. Drug treatment. For these purposes, antipsychotic drugs, neuroleptics, anticonvulsants, antidepressants and tranquilizers are most often used.
2. Psychotherapy, including family therapy, cognitive behavioral therapy, psychoanalytic techniques and cognitive training.
3. Social therapy.

Alternative treatments for schizophrenia include:

• insulin comatose therapy;
• electroconvulsive therapy;
• treatment with folk remedies;
• fasting treatment;
• physiotherapy in combination with balneotherapy;
• acupuncture and others.

Typically, schizophrenia is treated on an outpatient basis at home, but the advanced stage of the disease requires hospitalization of the patient in a hospital or a specialized psychiatric clinic. This may be necessary in cases where the patient poses a danger to himself and others due to unmotivated aggression.

Summing up

Schizophrenia is a serious and incurable mental illness, but with timely treatment, stable and long-term remission can be achieved, allowing the patient to live a normal life, work and start a family. There are many varieties and forms of this disorder, but almost all of them can be treated, subject to timely consultation with a doctor, correct and qualified diagnosis of the disease, as well as subsequent prevention of the disease.

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What's next?

I don't want to suggest that the concept of schizophrenia is useless.
Many psychiatrists consider it a useful clinical syndrome that helps identify a group of people with specific needs. Its biology is not yet clear, but many patients with it exhibit similar genetic characteristics. Some people may benefit from a diagnosis of schizophrenia. It will help them access treatment and improve support from family and friends. Give a specific name to their problems. Prove that they suffer from an illness and not from personal shortcomings. Of course, this doesn't help many people. It is necessary to maintain the advantages and discard the disadvantages of the term "schizophrenia" as we move into the post-schizophrenia era.

What it will look like is still unclear. Japan recently renamed schizophrenia “integration disorder.” We've already seen the idea of ​​psychosis spectrum disorder. But historically, the classification of mental illnesses was the result of a struggle in which “the most famous and best-expressed professor won.” The future must be based on evidence and discussion that includes the perspectives of people suffering and coping with these feelings.

Whatever is born from the ashes of schizophrenia should provide better ways to help people struggling with real problems.

Simon Macarthy-Jones is Associate Professor of Clinical Psychology and Neuropsychology at Trinity College, Dublin.

The genius of schizophrenics

What is the genius of schizophrenics? History stubbornly asserts that the most piercing and subtly felt works of art were created precisely by people suffering from one or another mental disorder.

• The author of the painting Saturn Devouring His Son, Francisco Goya, did not seem to suffer from mental illness. But it is noteworthy that he painted this and a number of other paintings alone and in old age, throwing away his brushes and palettes, with his bare hands, right on the walls of his house. Imagine, this fresco decorated the artist’s dining room and, looking at it, he had lunch every day.

Where is the line between mental illness and genius?

• When the artist painted his frescoes, he was deaf and almost blind. Researchers believe that he suffered from syphilis, which, in addition to blindness and deafness, causes insanity. In his bedroom, Goya placed another fresco, striking in its truthful cruelty, in which three goddesses of fate fly across the sky.

VIDEO: Black paintings by Goya

• School textbooks usually tell in detail about the circumstances of Sergei Yesenin’s life, but say nothing about the details of his death. The poet suffered from binge drinking, shortly before his death he was treated in a psychiatric hospital, and committed suicide. The poet’s mental torment is also reflected in his lyrics.

Yesenin's "Inner Demon"

• the painting “The Scream” by Edvard Munch. The place depicted in the picture is real: it is a bridge not far from which there are two terrible places - a slaughterhouse, from which the cries of dying animals can be heard, and a clinic for the mentally ill, where the artist’s sister was treated. The fate of the painter himself was difficult; at the age of 5 he lost his mother, who died of tuberculosis. It is known that he constantly redrew his painting “The Scream”, and also that the artist also underwent treatment in a psychiatric hospital.

“The Scream” is a poignant painting by a mentally ill artist

Forms of schizophrenia

No matter how this disease has been studied, there are still many mysteries about it. There are various forms and types of mental disorder, but a complete clinical picture is not available. In simple words, this means that there are no unambiguous symptoms for this pathology. Also, with this disease it is impossible to give any specific prognosis. For some patients, one course of powerful drug therapy will be enough; for others, long-term hospital treatment may be indicated. It is simply impossible to foresee all scenarios for the development of events with such a disease.

The classic classification of schizophrenia identifies four main types of the disease, but several years ago WHO made some amendments to it. This disease has ICD 10 code F20. DSM-4 and ICD-10 distinguish the following main types of schizophrenia:

• paranoid;
• hebephrenic or disorganized;
• catatonic;
• residual or residual;
• simple;
• undifferentiated;
• post-schizophrenic depression.

Let's take a closer look at each of these types.

Paranoid

Paranoid or paranoid schizophrenia is one of the main types of the disease, characterized primarily by the presence of hallucinations and delusions. Depending on the predominance of one or another variant in which the clinical picture of the disease is expressed, subtypes of paranoid schizophrenia are distinguished.

The following developmental features are characteristic of delusional paranoid schizophrenia:

• false distorted beliefs that defy common sense and logic, but are perceived by the patient as genius;
• delusions of grandeur;
• delirium of ingenuity;
• delirium of jealousy and others.

Depending on the type of delirium, a person’s behavior also changes. Most often, this syndrome leads to the fact that the schizophrenic becomes unable to fulfill his work and family responsibilities, as well as to complete maladjustment in society.

The hallucinatory subtype of paranoid schizophrenia is characterized by the presence of visual, tactile, and especially auditory hallucinations in the patient. Patients often hear various voices that threaten, order, comment and condemn various actions and actions of the patient. They can sound both outside and in the patient’s head, which is interpreted by the sick person as violent, invested or induced thoughts by someone else. This concept is called pseudohallucinations.

Catatonic

Catatonic schizophrenia is a psychosis in which significant deviations in motor function appear, while the patient’s consciousness remains completely clear. The catatonic form is characterized by sudden and sharp freezing of the patient in an awkward position for a long time, muscle spasms and a complete absence of speech. This phenomenon is called catatonic stupor.

Catatonic arousal almost always manifests itself spontaneously and impulsively: the patient may suddenly scream or run somewhere, as well as show causeless aggression towards himself or the people around him.

In the catatonic form of schizophrenia, there are no symptoms such as delusions and hallucinations. The patient is fully aware of what is happening, reacts soberly to events and words addressed to him. Information is perceived by him in full. After the condition has stabilized, the schizophrenic remembers everything that happened to him. Thus, it turns out that a person is simply unable to control his movements and actions, maintaining constant clarity of consciousness.

Hebephrenic

Hebephrenic, hebephrenic or disorganized schizophrenia is the most unfavorable of all forms in terms of further prognosis. It usually begins in adolescence, but can manifest itself in both teenagers and adults. In this case, there is a significant impairment of emotional and volitional function. With this diagnosis, patients are constantly in a silly and cheerful mood, behave inappropriately, and their appearance resembles children. They completely lack attachment to loved ones and feelings. Negative signs of the disease continuously increase, and, in the end, the patient stops communicating with others, understands them, and becomes unable to work.

Simple

Simple schizophrenia develops gradually, and this type of psychosis is characterized by the absence of attacks of psychopathy. The patient behaves withdrawn, his emotions noticeably become poorer, features of autism appear, although aggression, hallucinations, delusional states and catatonic effects are completely absent. It should be noted that the slow progression of the disease does not guarantee a favorable prognosis. As a result, everything still ends in the formation of an emotional-volitional defect characteristic of schizophrenia.

Residual

Residual or residual schizophrenia is a disease in the chronic stage, the essence of which is the manifestation of residual negative symptoms after an attack of psychosis. This form appears in:

• lack of emotions;
• passivity and apathy;
• retardation in psychomotor development;
• decreased volitional function;
• severe impairment of speech function.

There are also other typical types of schizophrenia, as well as an atypical form of the disease, differing in the type of course: periodic or recurrent, fur-like, malignant, sluggish. Let us briefly describe each of these types.

Periodic, recurrent, circular schizophrenia or schizoaffective disorder is characterized by sharp outbursts of hallucinatory delusions with a strong emotional and expressive coloring. Moreover, the more strongly the emotions are expressed against the background of an attack of hallucinations or delusions, the more favorable the prognosis for this type of disease will be. Serious symptoms can be relieved with the help of medications, and the next attack may recur after quite a long time, or not recur at all.

Coat-like or paroxysmal schizophrenia increases from attack to attack. Even after appropriate treatment, residual symptoms of psychosis, such as hallucinations or delusions, appear. Attacks in this form of the disease occur quite often, and if at the beginning of the disease the patient understands that he is carrying outright delusions and that he is overcome by hallucinations, then with each new attack he believes more and more in his undeniable genius and considers delusional ideas to be logical and smart thoughts. Such attacks can last from several weeks to several years, and in the intervals between them the disease only progresses. At the same time, the degree of progression and depth of mental disorder change significantly: sometimes approaching schizophrenic dementia, and sometimes closer to sluggish schizophrenia.

Malignant schizophrenia is permanent. It can manifest itself in childhood and adolescence, but most often its onset occurs in adolescence, and therefore it is also called juvenile schizophrenia. With this form of the disease, the patient is unable to be in society, loses all social skills, and shows aggressiveness towards himself and the people around him. Such patients are unable to work or even care for themselves. Remissions for this disease are quite rare and short-lived, and therefore patients with this form of mental disorder are almost always found in specialized clinics, as they can pose a danger to themselves and other people.

Sluggish schizophrenia or schizotypal disorder has many other names: neurosis-like, latent, pseudoneurotic, psychopath-like and others. Symptoms of such a disorder are present in a person in a mild and mild form, the disease occurs in a form that is not dangerous to others, but it is precisely this disorder that ultimately leads to quite serious consequences.

Febrile schizophrenia or lethal catatonia is a severe form of mental disorder, accompanied by various phantasmagoric visions, movement disorders, febrile syndrome, confusion, hyperthermia, bruising and elevated body temperature. Such conditions are life-threatening for the patient, as they can lead to brain swelling and failure of other internal organs. Therefore, febrile schizophrenia always requires emergency care.

There are also other types of schizophrenia:

• depressive and manic, which must be distinguished from a disease such as bipolar affective disorder;
• post-traumatic or post-traumatic stress disorder;
• juvenile;
• nuclear.

Impact on life

Determining the prognosis for a particular patient is not easy, since the course of the disease is influenced by a large number of factors. Among them are favorable: female gender, onset of the disease at a late age, manifestation through an acute episode, mild negative symptoms, positive personal relationships with people, maintaining professional and social activity. In addition, social acceptance of the patient can reduce the risks of further progression of mental disorder.

Is manic schizophrenia inherited?

As mentioned above, the disease has a genetic predisposition. It can manifest itself under unfavorable social conditions or against the background of organic brain damage. When sick children are born, their behavior should be carefully assessed during childhood for timely detection of pathology.

Against the background of complex therapy, begun in the early stages of the disease, the severity of symptoms quickly decreases, and the person returns to normal life. The period of remission can last several years or more. With late diagnosis and ineffective treatment regimens, the pathology progresses, leading to irreversible changes in personality and cognitive sphere.

Course of the disease

Schizophrenia is a progressive disease, and based on this, experts distinguish three stages of its development. Let's look at each of them in more detail.

Prodromal stage

Initial or mild stage of schizophrenia. This early stage of the disease is characterized by the presence of atypical symptoms, that is, schizophrenia at this stage is quite difficult to diagnose until it enters the active phase. It is often also called the latent stage, since such symptoms are characteristic of people with other mental illnesses, for example, depression.

Patients in this state stop communicating with relatives and friends, may spend long periods of time locked in their room, lose interest in various types of entertainment, and show signs of mental suffering, dulled emotions and decreased motivation. They don't want to go to school or go to work.

The onset of the disease often occurs in childhood or adolescence. Such children are characterized by loneliness, they show apathy towards watching films or cartoons. They are characterized by complete apathy and indifference to the world around them. It turns out that symptoms of schizophrenia may be present long before the characteristic signs of the disease appear.

Stage of psychosis

The second stage of schizophrenia is the stage of psychosis, which is characterized by an exacerbation of the disease. The acute or active stages of the disease are characterized by the presence of delusions, hallucinations, unmotivated aggression and serious impairments in the cognitive area. At this stage of mental disorder, full development occurs.

Often this most severe stage of the disease requires hospitalization in a hospital, since the patient can pose a danger to himself and to the people around him. In a hospital, such a disease is treated with antipsychotics, and without treatment, this stage can have serious consequences, even death.

Residual stage

The third and final stage of schizophrenia is the final stage of the disease. Symptoms at this stage are very similar to the prodromal stage of the disease. At this stage, attacks of psychosis are usually absent or episodic. But even without acute psychosis, patients experience various negative symptoms: lack of emotions, low energy, depression and stress. Hallucinations and delusions are also absent in the residual stage of the disease.

Causes

Since the symptoms are not very clear, schizophrenia combines a group of mental disorders, so there are no specific reasons for its occurrence.

However, we can consider the following causes of the disease - psychological, social and biological, as well as biopsychological and mixed.

Biological reasons

Biological factors that provoke the development of the disease are represented mainly by the characteristics of the functioning and development of the body.

1. During pregnancy, the mother may contract viral diseases, or the child may contract them in early childhood. Presumably, the causes may be rubella virus, Epstein-Bar virus, herpes of the first and second types, as well as cytomegalovirus.
2. In 7-10% of situations, genetic factors determine development in the presence of the disease in one of the parents and in 50% of cases in pairs of identical twins.
3. Autoimmune factors involve the fetus reacting to immune system antibodies produced by the mother in response to certain viral infections.
4. Intoxication can provoke not only schizophrenia-like symptoms, but also the manifestation of the disease.

Psychological reasons:

difficulties in formulating thoughts;

self-absorption and isolation;

communication problems, abstract reasoning;

high sensitivity to stress, problems in overcoming it;

stubbornness, suspiciousness and passivity;

sloppiness;

a kind of vulnerability: the death of a loved one may not affect you, but a minor nuisance hurts too much.

Social reasons:

• stress;
• seminal situation (dominant, overly emotional or expressive mother);
• urbanization (the number of diagnosed situations in rural areas is significantly lower than in cities).

In most cases, medical experts are convinced that a clear differentiation and division of causes into these groups is difficult, since in this case we are talking about a group of diseases of biopsychosocial origin, and accordingly, the causes must be complex.

For example, in the presence of a biological predisposition, adverse psychosocial factors play a key role.

How to deal with someone with schizophrenia

Living with a schizophrenic is very difficult, but it is necessary to make every effort to help a loved one cope with this serious illness. It is also worth remembering that you also need help yourself.

During periods of exacerbation of the disease, you should pay attention to the patient’s behavior in order to notice changes in the mental state in time and seek help from a doctor. Also, close relatives may insist on compulsory treatment in a psychiatric clinic if the patient, in a state of passion, may cause harm to himself or others.

Nutrition

During the period of remission, the patient's diet should be monitored. A properly selected special diet for schizophrenia will help to significantly prolong the interictal period and reduce negative symptoms. Products for this disease should not contain gluten and casein and be rich in vitamins, microelements, antidepressants and various enzymes. These products include: fermented milk products, lean fish and meats, fresh vegetables, almonds, bananas, fruits, dried fruits and others. You should drink natural freshly squeezed juices and homemade compotes.

Care

The patient’s relatives should provide him with full care immediately after discharge from the hospital, or do everything possible to prevent him from ending up there. First, it is necessary to strictly monitor the intake of medications during maintenance therapy. Secondly, the patient should be interested in something, keep him busy with some kind of work. At the same time, the work must have meaning and be useful to someone. Relatives and friends of a schizophrenic need to understand that many people consider such people strange and wonderful. Therefore, they should learn to live with these oddities, try not to notice them, treat their quirks with patience, and in no case joke or mock them.