MRI for schizophrenia. Schizophrenia: morphological changes in the brain Incorrect chemical processes in the brain in schizophrenia

EEG, or encephalography, allows you to detect the smallest changes in the activity of the cerebral cortex. This method helps to assess such features of the brain as the ability to memorize and process information. Data analysis is carried out on the basis of the features of changes in the synchronization of a number of brain rhythms. EEG in schizophrenia is used rather as an auxiliary method, since a similar specificity of changes in the functionality of the brain is also observed in some other diseases, including organic lesions of the central nervous system.

When sick, patients see non-existent images and events of various forms.

Despite a long history of study, schizophrenia is still the main mystery of modern psychiatry. The fact is that the manifestations and course of the disease are well studied, but the reasons for its development still raise a number of questions. In addition, medicine today has nothing to oppose this disease, so schizophrenia remains an incurable disease, although its symptoms can be successfully stopped with medications.

A few facts about psychopathology:

first manifested at the age of 22-35 years;
in women it occurs in a milder form, in men it often manifests in adolescence;
there are several severe forms of the disease, some of them are characterized by permanent progression;
different paroxysmal course;
untreated leads to a split personality.

Symptoms of the disease are very diverse and are divided into two large groups - productive and negative. Productive symptoms are signs of exacerbation of the disease, which include hallucinations, delusions, paranoid syndrome, catatonic manifestations. Hallucinations are auditory, visual, less often - tactile and olfactory. In the vast majority of cases, the patient is faced with voices in his head that make him do something against his will. Delusional disorder in schizophrenia manifests itself as an acute psychosis with obsessive thoughts and ideas. It may seem to the patient that he is being pursued by enemies, or he needs to stand at the head of the army. Since delirium is accompanied by hallucinations, a person is completely confident in the reality of everything that happens and can react aggressively to attempts by outsiders to interfere with his actions, no matter how crazy they really are.

The paranoid syndrome manifests itself in the fear of persecution, and the patient is sure that the whole world is against him. In general, paranoid symptoms can manifest in a variety of forms, from mild restlessness and anxiety to an obsessive belief that the patient is in dire danger.

Catatonic manifestations are a stupor, during which the patient freezes in any, even the most uncomfortable, position, not responding to stimuli and not entering into conversations. This behavior is preceded by mania - general emotional excitability, inappropriate behavior, anxiety, repetitive meaningless movements or phrases.

Despite acute manifestations, productive symptoms are quite successfully stopped by special preparations.

Negative symptoms are signs of a change in a person's personality. These include a flattened affect, social maladaptation, a tendency to vagrancy and gathering, inadequate hobbies, general depression and suicidal thoughts. Such symptoms indicate a decrease in the activity of the cerebral cortex and can lead to cognitive impairment and dementia. Negative symptoms are much more dangerous than the specific manifestations of schizophrenia, as they are more difficult to treat and can lead to dangerous consequences, such as suicide.

In general, the disease usually develops gradually, proceeding in the form of exacerbations, between which there is a period of relative clarity of mind. In some cases, continuous medication helps to completely eliminate the symptoms and achieve a stable remission. In psychiatric practice, there are many cases when the disease had only one episode, and after prolonged drug therapy, the patient no longer showed signs of schizophrenia until the end of his life.

Electroencephalography allows you to get the necessary information about changes in brain activity

It has been proven that patients with schizophrenia have an increased production of dopamine, which leads to disruption of the activity of different areas of the brain. Thus, the EEG in schizophrenia shows a noticeable increase in the intensity of work in the brain stem structures and a change in the activity of cortical neurons. At the same time, such signs are not enough to clarify the diagnosis (the form and specificity of the course of the disease), therefore, EEG is used as an auxiliary diagnostic method, mainly to exclude other pathologies, such as epilepsy or organic brain damage.

To obtain an accurate picture, it is necessary to study the activity of the brain during an exacerbation of the disease, when productive symptoms appear, but this is often impossible due to the aggressiveness of the patient and for a number of other reasons. At the same time, during periods of “enlightenment”, the bioelectrical activity of the brain of a patient with schizophrenia practically does not differ from the specifics of the brain of an absolutely healthy person.

Changes in the bioelectrical activity of the brain

Electroencephalography in schizophrenia with productive symptoms reveals the following bioelectrical disorders in the brain:

reduced alpha index;
excessively high synchronization of different rhythms in the temporal and frontal lobes of the cortex, mainly in the paranoid form of pathology;
reduced beta-index of the right hemisphere with severe negative symptoms, increased in the left hemisphere with severe productive symptoms;
increased activity of the right hemisphere with manic-delusional symptoms, shift towards the left hemisphere - with severe depressive symptoms.

Interestingly, brain activity in patients with severe forms of schizophrenia resembles the clinical picture characteristic of people taking heavy psychostimulants and amphetamines.

In addition, with this diagnosis, there is often a weakening of the bioelectrical activity of the frontal lobe.

Changes in gamma rhythm and interhemispheric relationships

The gamma rhythm is the highest frequency rhythm of brain activity, therefore it is the leading one in determining functional disorders. This indicator reflects the activity of some neural connections that determine the course of cognitive processes and the response to the action of neurotransmitters.

In psychosis against the background of schizophrenia, the following changes are observed:

increased rhythm power in the prefrontal cortex;
weakening the relationship between the hemispheres;
change in the activity of the hemispheres.

So, the EEG of the brain in schizophrenia shows a shift in activity towards one hemisphere, and for men, the pathological activity of the right hemisphere is characteristic, and for women - the left. This largely explains the specificity of the manifestation of the disease in men and women.

Electrooculography and Electrodermal Activity

The procedure helps to diagnose the development of psychopathology

Electrooculography (EOG) in schizophrenia shows a violation of the movement of the eyeballs - they become intermittent, “twitchy”, while in a healthy person they move smoothly, along a sinusoid.

The study of electrodermal activity determines the change in the emotional state in response to skin irritation. In schizophrenia, there is a decrease in the nerve conduction of the epidermis.

Interestingly, this change in normal response is considered by some experts to be the first manifestation of the disease, which can be diagnosed already in early childhood.

conduction of the facial muscles

With schizophrenia, there is a paucity of facial expressions and low emotionality. However, electromyography (a study of the conduction of the facial muscles) reveals increased muscle activity in response to emotionally provocative factors, while the patient's face remains outwardly impassive and indifferent.

Deciphering the results

Having examined whether EEG and other neurophysiological examinations can reveal the diagnosis of schizophrenia, it becomes clear that mental tests and observation of the patient's behavior remain the main diagnostic criteria. Deciphering the results of the EEG in schizophrenia allows you to get a more complete picture, but the method still remains auxiliary, and not the main one in the diagnosis of this disease.

At the same time, a neurophysiological study sometimes allows us to assume the possible development of a disease in a person in the future by the nature of the current changes in the bioelectrical activity of the brain.

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Schizophrenia is a disease of the brain

1. What is schizophrenia

Schizophrenia is a brain disease that usually begins between the ages of 17 and 25. The characteristic symptoms of this mental disorder are hallucinations - when the patient hears voices or sees objects that other people do not hear or see - and various forms of delusions, i.e. expressing untrue ideas, such as that someone is trying to harm him or putting bad thoughts in his head.

Patients with schizophrenia may talk strangely and do meaningless things. They may withdraw from normal activities, such as not attending school, going to work, and socializing with friends, and instead tend to be alone, shutting themselves off from contact with other people, or sleeping for long periods of time. Such patients may neglect the rules of personal hygiene.

A person with schizophrenia behaves in many ways differently than before the disease, but they are not two different people, and his personality is not split.

2. What are the causes of schizophrenia

Currently, scientists do not know the causes of schizophrenia, and one hypothesis says that some people are prone to developing this disease from birth. Some researchers believe that schizophrenia may be caused by a virus that infects the brain of an unborn fetus. Others believe that stress, which can be the result of a variety of situations, such as school, work, love conflicts, the birth of a child, etc. Allow schizophrenia in persons predisposed to it. There is, however, no evidence that the causes of schizophrenia are difficult relationships in the family or the bad attitude of parents towards the child.

3. What is the probability of getting schizophrenia

For each individual person, the likelihood of getting schizophrenia is small. In the absence of schizophrenia in family members, the chance of not getting schizophrenia is 99 out of 100. For a person whose brother or sister has schizophrenia, the chance of not getting sick is 93 out of 100.

If one of the parents suffers from schizophrenia, then the chance of getting sick for the child is 10-12%. In cases where both parents suffer from schizophrenia, the likelihood of this disease in a child increases to 46%.

For many patients with schizophrenia, family life and love relationships develop quite successfully. People with schizophrenia can also be good parents. Despite this, many people with schizophrenia believe that they should not have children. They know that raising children is very emotional and that the child does not tolerate separation from parents, who sometimes have to be hospitalized for treatment of schizophrenia.

4. How is schizophrenia treated?

Medications are the primary treatment for schizophrenia. These include such well-known drugs as Halopyridol, Orap, Semap, Triftazin, Tizercin, and others. These drugs help correct strange behavior in patients, but they can also cause side effects such as drowsiness, hand tremors, muscle stiffness, or dizziness. To eliminate these side effects, it is necessary to use the drugs Cyclodol, Akineton. Drugs such as Clozapine, for example, cause fewer side effects, but regular blood tests should be done while taking Clozapine. Recently, new generation drugs have appeared, such as Rispolept, which have a minimum number of side effects, which can significantly improve the quality of life of patients.

Supportive psychotherapy and counseling are often used to help a person with schizophrenia. Psychotherapy helps people with schizophrenia feel better about themselves, especially those who experience irritation and feelings of worthlessness as a result of schizophrenia, and those who seek to deny the existence of this disease. Psychotherapy can equip the patient with ways to deal with everyday problems. Currently, most schizophrenia experts believe that psychotherapy should avoid looking for the causes of schizophrenia in childhood events, as well as actions that evoke memories of bad past events.

Social rehabilitation is a set of programs aimed at teaching people with schizophrenia how to maintain independence, both in the hospital and at home. Rehabilitation focuses on teaching social skills for interacting with other people, skills needed in everyday life such as managing one's own finances, cleaning the house, shopping, using public transport, etc., vocational training, which includes activities necessary to obtain and job retention and continuing education for those patients who want to graduate from high school, go to college, or graduate from college; some patients with schizophrenia successfully receive higher education.

A day treatment program consists of some form of rehabilitation, usually as part of a program that also includes drug therapy and counseling. Group therapy is aimed at solving personal problems, and also enables patients to help each other. In addition, social, recreational and labor events are held within the framework of daily programs. The day treatment program may be hosted in a hospital or mental health center, and some programs provide accommodation for patients discharged from the hospital.

Psychosocial rehabilitation centers, in addition to participating in many activities of the day treatment program, offer mentally ill people to become members of a social club. It should be remembered, however, that such programs do not provide medication or counseling and that they are not usually associated with a hospital or local mental health center. Their main purpose is to provide patients with a place where they can feel at home, and in job training that prepares members of the social club to perform certain professional duties. Such programs often provide for patients to live in "collective" houses and apartments.

Leisure centers, which are not usually part of the treatment program, play a very important role in improving the lives of people with schizophrenia. Some of these centers are owned by associations of the mentally ill, and many are run by clients, i.e. people who themselves suffer from mental disorders. Leisure centers are usually open for a few hours during the day or evening to provide an opportunity for people with schizophrenia or other mental disorders to spend time with a group of friends and participate in social or recreational activities.

5. How people with schizophrenia can help themselves

Take medication. 7 out of 10 patients will relapse (symptoms of the disease will reappear) and may even require hospitalization if they do not follow the prescribed medication regimen. Patients should tell their doctors which medications work best for them, as well as speak frankly with doctors about any side effects.

Do not use alcohol and drugs. These substances can also cause a relapse or worsen the symptoms of schizophrenia. Alcohol and drugs are harmful to the brain and make recovery difficult.

Watch for signs of an impending relapse. Poor sleep, irritability or restlessness, difficulty concentrating, and feeling full of strange thoughts are signs of a return of schizophrenia. Patients should report these warning signs to family members and physicians.

Avoid stress. Coping with stress is difficult, even for healthy people. In some patients, stress can exacerbate schizophrenia. Patients should avoid activities or situations that cause them tension, irritation, or negative emotions. Running away from home or walking on the road is not a cure for schizophrenia and, in fact, can exacerbate the condition.

Control your behavior. Most people with schizophrenia are not violent and do not pose a danger to other people. Some patients, however, feel worthless and think that other people treat them badly because they have schizophrenia. They may become irritable and take out their irritation on other people, sometimes family members who try to help them. It is important that patients with schizophrenia understand that they are no worse than other people, and follow the generally accepted rules of everyday communication with other people.

Use your abilities and talents. Patients with schizophrenia should do everything possible to recover. Often these are intelligent and talented people, and even despite strange thoughts, they should try to do what they have learned before, and also try to acquire new skills. The participation of such patients in treatment and rehabilitation programs, as well as the implementation of their professional activities or the continuation of education, to the extent possible, is important.

Join groups or join clubs. Joining a group or joining a club that suits the patient's interests, such as a church or music group, can make life more varied and interesting. Participation in therapy groups, support groups, or social clubs with other people who understand what it means to be mentally ill can improve the condition and well-being of patients. Survivor-led client or consumer groups help other patients feel cared for, shared, and understood, and increase their opportunities to participate in recreational activities and community life. Some groups also provide legal assistance to their members.

6. How can the family help the sick person?

Try to learn more about this disease. Family members behave more appropriately if they are sufficiently aware of schizophrenia and its symptoms. Knowledge helps them to correctly relate to the strange behavior of the patient and more successfully cope with the problems that arise due to this disease. The necessary information about schizophrenia and modern methods of its treatment can be obtained from support groups, medical professionals or gleaned from modern books.

Know what to expect from the patient. A person with schizophrenia usually needs long-term treatment. During treatment, symptoms may come and go. Family members should know what to expect from the patient in terms of household chores, work, or social interactions. They should not require a patient who has just been discharged from the hospital to go straight to work or even look for work. At the same time, they should not unnecessarily patronize their sick relative, underestimating the requirements for him. People with schizophrenia cannot stop hearing voices just because someone has forbidden them to hear them, but they are able to keep themselves clean, be polite, and participate in family activities. In addition, they themselves can contribute to the improvement of their condition.

Help the patient avoid stress. People with schizophrenia find it difficult to tolerate being yelled at, irritated, or told to do something they cannot do. Family members can help the patient avoid stress by following the rules listed below:

Do not yell at the patient and do not say anything to him that might piss him off. Instead, remember to praise the patient for good deeds.

Do not argue with the patient and do not try to deny the existence of strange things that he hears or sees. Tell the patient that you do not see or hear such things, but you acknowledge that they do exist.

Keep in mind that ordinary events - moving to a new place of residence, getting married, or even a festive dinner - can irritate people with schizophrenia.

Don't get too involved in the problems of a sick relative. Save time for your own needs and the needs of other family members.

Show love and respect for the patient. Remember that people with schizophrenia often get into trouble and sometimes feel bad about themselves because of the illness. By your daily behavior, show that your relative who suffers from schizophrenia is still a respected and loved member of the family.

Take part in the treatment of your relative. Find out which treatment programs are best for the patient and encourage him to take part in these programs; this is also important because in the process of participating in such programs, your relative will be able to communicate with other people besides his family members. Make sure that your sick relative takes his prescribed medicines, and if he stops taking them, try to find the reasons for this. Patients with schizophrenia usually stop taking medication because side effects are too severe or because they consider themselves healthy and therefore do not need medication. Try to keep in touch with the doctor and let him know which medicine is best for the patient.

7. Can the condition of patients with schizophrenia improve?

Undoubtedly! Studies have shown that the majority of patients whose symptoms of schizophrenia were so severe that they had to be hospitalized improved. The condition of many patients may become better than at present, and almost one third of patients may recover and no longer have any symptoms. In groups led by former patients, there are people who once had very severe schizophrenia. Now many of them work, some are married and have their own home. A small proportion of these people have resumed their college education, and some have already completed their education and got into good professions. New scientific research is constantly being carried out, and this gives reason to hope that cures for schizophrenia will be found. Our time is a time of hope for those with schizophrenia.

Bibliography

For the preparation of this work, materials from the site http://psy.piter.com were used.

What is schizophrenia?

Schizophrenia is one of the disorders that causes a number of discussions in professional circles. A significant part of the general public has distorted the concept of the disease. First of all, we must forget about the "split personality", because it has nothing to do with schizophrenia. The concept of illness can be translated as divided thinking, but otherwise, it is a disorder of many mental functions: thinking, perception, emotions. Violations can affect motor abilities, personal qualities, the ability to communicate with people, attention, memory. Schizophrenia refers to mental illness (psychosis). The disease affects about 1% of the population, i.e. every hundredth person.

Schizophrenia most often affects people aged 15-35 years, gender does not play a role. Some schizophrenics are completely cured, in others the disease becomes chronic. Sometimes it is called "disease ⅓", because about ⅓ of patients are cured, return to normal life, ⅓ achieve some improvement, but some manifestations periodically disturb the person, ⅓ of patients remain with chronic symptoms, do not respond to treatment. About 10% of patients end their lives by suicide.

Schizophrenia is economically costly. Many patients have limited working capacity.

The nature and causes of schizophrenia

The causes of schizophrenia are not known. In the brain of patients, high levels of dopamine are often found, some infections, viral attacks, stress, and poor family communication can play a role.

To answer the question of where schizophrenia comes from, it is important to understand that the disease is primarily a perceptual selectivity disorder. The schizophrenic perceives much more information than he needs, and because he cannot process it, his brain creates its own acceptable reality.

The nature of schizophrenia is a violation of the selectivity (selectivity) of perception. What's this? A person is always exposed to many stimuli, but he chooses only those that are important at the moment. For example, when crossing a road, we are interested in whether something is driving on the right and on the left, whether the road is slippery, how much we are in a hurry. The fact that 2 people are talking next to us, there is a trash can on the sidewalk, new shoes on our feet do not interest us, because it has nothing to do with crossing the road. This is a natural defense against overloading with irrelevant information. In schizophrenia, this protection is violated - the patient perceives everything. The human brain is not capable of perceiving so many stimuli, so confusion arises. At the same time, people have a natural tendency to put things in order, to understand them. A person suffering from schizophrenia, in this confusion, creates a certain system - it gives meaning to all things. However, some of his explanations are strange from the point of view of a healthy person - we are talking about manic ideas.

With the development of schizophrenia, the causes of the disease include. If both parents are schizophrenics, the risk of developing a congenital disease in children is 40%. But about 80% of patients do not have close relatives with this diagnosis.

Is it possible to get schizophrenia in childhood? Can. A risk factor for the development of childhood illness is damage to the fetus during the perinatal period. This happens with maternal diseases (for example, epilepsy), the use of alcohol, drugs during pregnancy.

Like depression, the development of schizophrenia is significantly influenced by biochemical conditions in the brain. In particular, increased levels of dopamine, norepinephrine, or other neurotransmitters (chemicals that provide communication between single-stranded). Most of the drugs used in the treatment of the disease reduce the amount of dopamine in the brain.

Some schizophrenics also have structural changes in the brain - usually enlarged chambers. The influence of some viral diseases that can damage the brain, as a result of which a disorder can develop, is taken into account.

The debut of schizophrenia can occur in combination with any burdensome situation, mental pain (family separation, death of loved ones, severe stress, emigration, etc.). Triggers that can result in disease include the use of marijuana, amphetamines, hallucinogens, and other drugs.

Often negative circumstances are found in the family during a person's life - a negative impact during pregnancy, problems during childbirth, improper upbringing. The main negative factor is the so-called. double bond, a situation in communication when the mother provides the child with two conflicting information - she strokes the child on the head, but scolds him; says that she loves him, but does it indifferently.

Therefore, for the formation of schizophrenia, 2 points are needed:

certain vulnerability (predisposition, disposition);
trigger (stress, drugs, etc.) that activates the disease.

Symptoms of schizophrenia

No two schizophrenics are the same. In some patients, the symptoms of the disorder are varied and expressive, in others they are inconspicuous. Features can be combined in various ways. Symptoms are classified into 2 groups: positive and negative.

Positive symptoms

Positive signs are hallucinations, sensations that have no support in reality. They are created in the human head, most often, we are talking about voices. This group includes manias, thinking by constructions, also without support in reality. As a rule, this is the belief that someone is persecuting the patient. The next positive symptom is disorganized speech, meaningless behavior.

Negative symptoms

Negative symptoms are a manifestation of emotions, abulia (a pathological lack of motivation, will, desires), slow or almost absent speech. The group of negative symptoms includes anhedonia - a person cannot experience pleasure, joy, there is nothing that could make him smile.

At first glance, it may seem that positive symptoms are worse. But it's not. Negative signs are more difficult to treat, they alienate a person more from the outside world, cause inability to work, etc. Positive symptoms improve with the help of psychotherapy, special exercises, negative ones require a comprehensive long-term therapeutic approach.

To be diagnosed with schizophrenia, symptoms must persist for at least 1 month.

Other symptoms and changes

Personality changes. A person can act rude, not take care of himself. Violated attention, memory, general mental performance. A typical manifestation is suspiciousness, resentment.

Emotions. The patient becomes unpredictable, inadequate, his mood often alternates; ambivalence is widespread (lack of unity of perception - a person does not know whether he likes something or hates it).

Thinking. The schizophrenic thinks stereotypically, according to his own peculiar rules. For each phenomenon, he needs to find some explanation. Approximate situation: a person goes to the park, and a branch falls from a tree near him. A healthy person does not pay any attention to this phenomenon, but a schizophrenic studies the reasons why this happened, comes to the only and irreversible conviction that he is being persecuted. Due to the inability to orient in one's own thoughts, some of them are considered by the patient as not their own - a feeling of the presence of other people's thoughts is manifested. There is a "stop thinking".

Speech. This is a reflection of thought, so it can be scattered, full of neoplasms, repeated words. Typically, the appearance of "word salad" when a person uses together words that are completely unrelated to each other. A schizophrenic may stop talking completely (mutism appears).

Social area. Typical for the disease problems in the field of communication, self-confidence, self-affirmation, overcoming aggression. The patient closes in himself, lives in his own world.

hallucinations in schizophrenia

Hallucinations are perceptual disorders, they are sensations without an existing basis.

If someone is in the room, talking to you, you hear him speaking, that is perception. If you are alone in a room and you hear someone's voice, it is a hallucination. If you walk through the park at night, suspecting a threat in every natural sound, this is an illusion (a distorted perception, distinguished from hallucinations by the presence of a certain real basis).

With regard to sensations, hallucinations are divided into several groups.

Auditory (acoustic) hallucinations are the most common:

simple (acoasma) - whistling, moaning, blows;
complex - "voices" - they can command (urgent hallucinations), advise (teleological hallucinations), represent several voices (antagonistic hallucinations).

Visual hallucinations (optical):

simple (photomes) - spots, flashes, sparks;
complex - characters, landscapes, actions; this group includes zoopsia (animals), macropsia (perception of small objects by large ones); erythropsia (surrounding things seem red, fiery), autoscopic hallucination (a person sees himself).

Body hallucinations:

tactile - sensation of touching the body, itching;
cenaesthetic - an organ, for example, a stomach, consists of a stone, is absent, is different; false pregnancy (pseudokiez);
motor (kinesthetic) - a person, being at rest, is convinced that he is moving; someone moves him - this is a hallucination of possession;
verbal-motor or Segla's hallucinations - a person feels that someone is speaking through his mouth;
graphic-motor - someone controls the patient's hands, writes with them.

Taste and olfactory hallucinations:

often complex (feeling that the food is poisoned, something smells, etc.).

Other:

intrapsychic or hallucinations of Beilarger - someone puts in the head or steals the thoughts of the patient;
inadequate - feelings of inconsistency of organs (for example, a person is convinced that he sees with his mouth);
negative - the patient does not see what is really there;
hypnogenic - when falling asleep it is impossible to distinguish reality from sleep;
pseudo-halusions - the person realizes that unrealistic perceptions are taking place.

Manias and syndromes in schizophrenia

Mania is an erroneous, unhealthy belief that cannot be refuted by any arguments. Depending on the content, manias are divided as follows:

paranoid syndrome - a person refers everything to himself (everyone looks at him, slander, want to hurt him, control him, etc.); a complete distrust of people develops;
persecution - the belief that someone is persecuting a sick person in order to harm him;
querulant syndrome - the person in question sees many shortcomings around him; mania is manifested by constant discontent and instructions;
emulation - refers to jealousy; the belief that the partner has a lover (lover);
erotomania - a person is convinced that he is loved by a famous, important person; the disorder is often associated with attempts to contact her;
expansive mania - typical overestimation, exaltation;
extrapotential - confidence in one's extraordinary abilities;
megalomania - the patient perceives himself as someone important (for example, the president of the country or the Pope);
original mania - belief in one's noble origin;
inventory mania - the patient's confidence that he has invented something exceptional, necessary for mankind;
reform mania - confidence in the ability to reform society;
religious mania - beliefs associated with religion;
space mania;
depressive mania - nothing makes sense, lack of opportunities for a normal life;
micromania - a person is insignificant, cannot influence his life;
nihilistic mania - a person is so insignificant that he denies his existence.

Types

There are 7 main types of schizophrenia - diagnoses. But experts point to the obsolescence of this classification and the need for a new division. For example, the distribution of individuals with schizophrenic disorder depending on 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 they tend to get sick older people (senile neurosis). The disease is characterized by positive symptoms - mania, hallucinations. This type of schizophrenia is called paranoid because of the presence of paranoid manias. The patient may feel threatened by other people, intense jealousy, persecution, etc. The forecast is relatively optimistic.

F 20.1 - hebephrenic

It often occurs in young people (about 20 years old). Manifestations include neglect of duties, frequent use of vulgarities, witty philosophizing, silly jokes, strange thinking, strange whims. An adult woman or man often behaves like a teenager, for him the behavior of an "absolutely omniscient person" is typical. The 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. Movement disorders are typical for this type. It has 2 forms - locking and productive. With a stop form, a person partially or completely stops moving. If you raise his hand, he will hold out for a long time in this position. Some schizophrenics may not move for many years, but they are unpredictable - they can suddenly do something. The reason for immobility is hallucinated voices that forbid movement. The productive form is characterized by expressive, unorganized 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 disappearance of the schizophrenic episode.

F 20.5 - residual

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

F 20.6 - simplex schizophrenia

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

Treatment

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

Basal antipsychotics

This group includes the following medicines:

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

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

Incisive antipsychotic drugs

This group includes:

Prochlorazepin;
Fluphenazine (Moditen);
Perphenazine;
Haloperidol;
Flupentixol (Flyuanksol).

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: almost never happen.

Sometimes it is possible to prescribe the appropriate antipsychotic drugs on the first try, in some cases, an effective remedy is determined on the 2nd try. If the disease does not respond to drug therapy, you can use Clozapine (Leponex, with control of the blood picture due to possible side effects on hematopoiesis), the method of electroconvulsive therapy, electroshock. Because schizophrenia disrupts a person's functioning in major social areas, the patient needs additional psychological and social therapy.

Purpose of treatment and rehabilitation:

increase the patient's resistance to stress;
training in effective ways of communication, management of general requirements from the social environment;
relapse prevention.

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 from it (gluten is a well-known neurotoxin); limit other cereals;
reduce or eliminate red meat, milk, cheeses (except cottage cheese);
drink 2 liters of pure, unsweetened, non-carbonated water daily + 2 cups of any herbal tea;
recommended movement, swimming;
include in the diet a lot of fresh fruits, vegetables, dried fruits, seeds, fish;
for pH support, take 10 g of vitamin C per day;
5-8 tablets of the B50 complex (a strong form of the B-complex);
niacin - 1000-3000 mg per day;
fish oil, linseed oil are also recommended;
Lugol's solution - 4 drops in drinking water, 1 drop - grind under the thyroid gland;
Betaine HCL - 3 tablets with each meal;
it is recommended to use a multimineral/vitamin complex.

Prevention

Can the development of the disease be prevented? To some extent, yes. Schizophrenia is formed as a result of a combination of a predisposition and a trigger that activates this tendency. If there were no predisposition, the trigger would have nothing to take on; if there were no trigger, the tendency would remain latent.

Think of a predisposition to psychotic illness as an underground hornet's nest. You can walk around it for years, unaware of the danger. As a trigger, imagine a hoe with which one day you will begin to tear the ground above the nest.

It is impossible to influence predisposition. We are talking about a property of the nervous system that a person has inherited, a personality setting that has developed in connection with life circumstances (especially in early childhood).

But the trigger is different. As a rule, the inability to cope with severe stress, long or short, is involved in the development of the disease. The key is stressful circumstances that a person cannot cope with, increased anxiety, weakening forces - physical and mental.

Therefore, it is important to cultivate the ability to withstand stress, reduce its impact on the psyche, tame weaknesses (in addition to a tendency to schizophrenia, this may be a predisposition to depression, anxiety disorders, psychosomatic symptoms).

Data on the influence of stress as a trigger point to a higher incidence of schizophrenia among people who have traveled abroad. A foreign language, other burdens adversely affect their fragile psyche. While 99% of people can take on life changes without further problems, the predisposed person develops the disease. Schizophrenia is also more common in adolescents; puberty is a huge burden, entailing changes in the body, school requirements, emotional "jumps" in the first relationship.

Therefore, the prevention of schizophrenia (and other mental disorders) lies in the fact that a person with a hereditary predisposition, sensitive, unstable people should take into account the increased vulnerability of their psyche. In practice, we are talking about 2 areas. If you are one of those prone to illness, you definitely need to learn how to deal with stressful situations. This is not an automatic skill, if it is not passed on to a person by parents, it should be learned. The second key measure is that people under threat control their psyche and do not allow overexertion.

Without a trigger, there will be no schizophrenia. Some of them cannot be influenced, but many things can be kept under control by focusing on them.

Schizophrenia is a mental illness associated with the breakdown of emotional reactions and thought processes. The symptoms of this disease include delusions, hallucinations, disorganized thinking, as a result of social dysfunction.

Can an MRI show schizophrenia?

According to the latest data, the reasons for the development of this pathology are two factors, one of which is predisposition:

anomalies of the vascular bed of the brain: anterior and posterior trifurcation of the internal carotid artery, anomaly of the communicating artery of the brain
anomalies of the gray and white matter of the brain. More often, the pathology consists in local atrophy (a part of the brain).
pathology of the venous sinuses.
pathological activity in the frontal and temporal lobes of the brain.

The second factor is certainly important, so to speak, the triggering factor for the development of schizophrenia - this is a mental trauma, no matter at what age it first occurred, but childhood is more susceptible to mental trauma.

MRI as a method that is sensitive to the development factors of schizophrenia of the first group.

Anomalies of the vascular bed of the brain are perfectly revealed by such an MRI technique - angiography. Anomaly of the vascular bed occurs in a third of patients with schizophrenia. As a result of such a pathology as trifurcation (triple of the internal carotid artery, and normally doubling) of the right or left internal carotid artery, ischemia of a certain area of the brain occurs, which is a powerful predisposing factor.

Below are examples of neuroimaging of patients with schizophrenia using MRI technologies.

A patient with schizophrenia. MRI was performed — angiography in the patient revealed trifurcation of cerebral vessels. One of the frequent anomalies of the brain, a complication of which is schizophrenia.

This fMRI (functional MRI) image compares brain activity in a normal patient with a schizophrenic patient who also has an arterial trifurcation.

MRI for schizophrenia

Back in 2001, a group of researchers at the University of California reliably identified evidence-based MRI signs in patients with schizophrenia using only the classic T1 and T2 sequences.

These signs include

violations of the structure of the white matter of the brain. Pathology was more common in the temporal lobes in patients who were diagnosed with schizophrenia for the first time, and pathological foci were also detected in the frontal lobes, but this localization is more common in older patients who undergo repeated MRI examination.
The volume of the cerebral ventricle in patients with schizophrenia is larger.

If the second sign of schizophrenia is just a reliable sign that just a radiologist should always keep in mind, then the second sign led scientists to put forward a hypothesis about the work of the brain in schizophrenia. After the advent of such a method as fMRI (functional MRI), this hypothesis was confirmed. Indeed, specialists in diagnostics in the study of a patient with early schizophrenia (Figure below) reveals an increase in the signal in the frontal lobe, and with a late one in the temporal lobe (Figure below).

A patient with late schizophrenia has an undulating course. Performed fMRI according to which increased activity in the temporal lobe.

Patient with early schizophrenia

MRI - increased activity of the frontal and occipital lobes.

Brain MRI in schizophrenia

In this classic MRI, a patient with schizophrenia and a normal are shown on the left at the same head level. The difference is obvious: the arrow indicates the expansion of the lateral ventricles, a typical MRI sign in patients with schizophrenia, which we wrote about earlier.

Many psychiatrists do not fully understand the principle of the MRI method, its capabilities in particular fMRI and such a method as DTI, therefore they are often neglected. The last two MRI methods allow you to identify changes that occur in brain cells at the cellular level. Classical MRI protocols are good for visualizing such pathological changes in schizophrenia as a change in the substance of the brain, determining the size of the ventricle, to exclude such diseases that can simulate schizophrenia. For example, a person's consciousness and psyche changed dramatically, psychiatrists clinically diagnosed schizophrenia, and the patient turned out to have Alzheimer's disease, which was not difficult to detect with an MRI scan. Another case that ruled out the diagnosis was that a man had auditory hallucinations, a suspicion of schizophrenia. An MRI scan revealed a schwannoma of the acoustic nerve, which is a tumor. Therefore, from the point of view of evidence-based medicine, additional diagnostics is a necessary aspect of a correct diagnosis.

This picture shows a patient with Alzheimer's disease. Schizophrenia was initially suspected. On MRI: a decrease in the brain in volume, on the T2 sequence, a hyperintense area is visualized, indicating to us about chronic ischemic changes in the brain.

MRI shows schizophrenia

The fact that MRI is effective in diagnosing schizophrenia has long been proven by scientists. Researchers at the Friedrich Alexander University of Erlangen (Germany) in 2008 proved that MRI is able to differentiate (distinguish) diseases similar in symptoms to schizophrenia. Based on this study, reliable signs of schizophrenia on MRI are also described:

Vascular changes are congenital anomalies of the arteries, venous sinuses, anerisms of cerebral vessels. Due to the redistribution of blood flow in the brain, others are better supplied with blood, so this sign on MRI is also one of the triggering factors in the development of schizophrenia.
Signs of hydrocephalus - expansion of the lateral ventricles, an increase in the size of the third ventricle, expansion of the subarachnoid space. Expansion of the horns of the lateral ventricles
Damage to the white matter of the brain. More often it is atrophy of the white matter of the brain.
Chronic ischemia of the brain, which often occurs as a result of vascular changes in the brain.
Brain anomaly (developmental anomaly). The anomaly is localized in the brainstem, cerebellum, pituitary gland, which leads to functional impairment of these parts of the brain. Rathke's pocket cyst, Werge's cyst.

This information helps the radiologist in his work, so it is possible to say for sure that the radiologist will pay attention to one of these signs and draw the right conclusions about the diagnosis.

A patient with schizophrenia was diagnosed with a frequent concomitant disease (comorbid disease) Rathke's pouch cyst.

Does an MRI show schizophrenia?

In schizophrenia, there is a redistribution of blood flow in the brain, which is not always noticeable when scanning in classic MRI sequences. If you use fMRI (functional MRI), the diagnosis of pathological foci in the brain becomes easier. Schizophrenia does not always immediately show signs such as atrophy, vascular anomalies, and so on on an MRI. fMRI allows to suspect schizophrenia in a normal person without pathological symptoms in the form of hallucinations and mental disorders. In schizophrenia, certain areas of the brain are more susceptible to arousal. This is proven because abnormal areas of the brain release more dopamine. Some scientists suggest that this is a congenital pathology, which eventually makes itself felt after exposure to mental trauma.

This still clinically healthy young man was examined for MRI

Came in with headaches. Many noted that he had a twist, but they could not say anything bad about him. Classical MRI showed no significant changes in the brain in this patient. In fMRI, pathological activity in the frontal lobe is evidence of early schizophrenia.

The young man did not believe this diagnosis after 8 years, he turned again, but with more severe symptoms. On MRI in classical protocols there were already changes in the form of atrophy of the white matter of the brain. This patient may be a bad example for patients, but early treatment of this patient could have improved his quality of life.

Schizophrenia on MRI of the brain

MRI should be performed not only in patients with suspected schizophrenia for early diagnosis of changes, but also in patients with a long history of this disease for possible correction of treatment. A frequent sign on MRI in patients is atrophy of the brain substance. Some researchers believe that this process is not only associated with the spread of pathology, but also with the use of drugs, so the attending psychiatrist should also be interested in this. Brain atrophy is easily visualized in the same way as cerebral ventricular expansion, so it does not require complex MRI protocols that can assess nerve cell interaction (fMRI or DTI MRI). Progressive atrophy of the brain significantly impairs the patient's quality of life, so MRI monitoring is desirable every 6 months.

Absolute (monozygous) twins are presented. On the right is a patient with schizophrenia, and on the left is the norm. MRI was performed at the same level of the brain. The patient has a pronounced increased signal from the medulla, expansion of the ventricles, atrophy of the medulla.

The patient has psychosis - schizophrenia - manic course. MRI of the brain. Arachnoid cysts of the brain were revealed.

There are a great many questions about schizophrenia that scientists still cannot answer. But first, let's talk about the most important thing.

Schizophrenia is a very common mental illness. According to statistics, about one in 100 people in Australia suffered from it at some point in their lives. Thus, almost everyone has friends or relatives with schizophrenia.

Schizophrenia is a complex condition that is difficult to diagnose, but the listed symptoms are usually detected: mental activity, perception (hallucinations), attention, will, motor skills are disturbed, emotions are weakened, interpersonal relationships are weakened, streams of incoherent thoughts are observed, perverted behavior, there is a deep sense of apathy and feeling hopelessness.

There are two main types of schizophrenia (acute and chronic) and at least six subtypes (paranoid, hebephrenic, catatonic, simple, nuclear, and affective). Fortunately, schizophrenia is treated with cognitive therapy, but most often with medication.

There are many myths associated with schizophrenia. One of them is the view that this disease occurs more often in rural areas than in cities. Moreover, according to outdated information, schizophrenics from rural areas often move to cities to find solitude. However, scientists refute this myth.

A study of schizophrenia among Swedes indicates that urban dwellers are more susceptible to this disease and they do not move anywhere. Scientists say that the environment can push people to the disease.

But myths aside, the true source of schizophrenia is still a mystery. Previously, it was believed that the reason was the poor attitude of the parents towards the child - usually too reserved, cold mothers were blamed. However, this point of view is now rejected by almost all experts. The fault of the parents is much less than is commonly believed.

In 1990, researchers at Johns Hopkins University found an association between a reduction in the superior temporal gyrus and intense schizophrenic auditory hallucinations. It has been theorized that schizophrenia results from damage to a specific area on the left side of the brain. Thus, when voices appear in the head of a schizophrenic, there is increased activity in that part of the brain that is responsible for mental and speech activity.

In 1992, this hypothesis was reinforced by a serious Harvard study, which found an association between schizophrenia and a decrease in the left temporal lobe of the brain, especially that part of it that is responsible for hearing and speech.

Scientists have found a link between the degree of thinking disorder and the size of the superior temporal gyrus. This part of the brain is formed by a fold of the cortex. The study was based on a comparison of magnetic resonance imaging of the brains of 15 patients with schizophrenia and 15 healthy people. It was found that in patients with schizophrenia, this gyrus is almost 20% smaller than in normal people.

Although no new treatments have been proposed as a result of this work, the scientists believe that their discovery provides an opportunity to "further study this serious disease."

Every now and then, new hope emerges. A 1995 study conducted at the University of Iowa suggests that schizophrenia may be due to pathology of the thalamus and areas of the brain anatomically associated with this structure. Previous evidence indicated that the thalamus, located deep in the brain, helps focus attention, filter sensations, and process information from the senses. Indeed, "problems in the thalamus and its associated structures, extending from the top of the spine to the back of the frontal lobe, can create the full range of symptoms seen in schizophrenics."

It is possible that the whole brain is involved in schizophrenia, and some psychological representations, for example, about oneself, may have a certain connection with it. Dr. Philip McGuire says: "The predisposition [to hearing voices] may depend on abnormal activity in areas of the brain associated with the perception of internal speech and the assessment of whether it is one's own or someone else's."

Is there any specific time for the occurrence of such disorders in the brain? Although the symptoms of schizophrenia usually appear during adolescence, the damage that causes it can occur in infancy. "The exact nature of this nerve disorder is unclear, but [it reflects] abnormalities in brain development that appear before or shortly after birth."

There are experts who believe that schizophrenia can be caused by a virus, and a well-known one. A controversial but very intriguing version of the causes of the disease is put forward by Dr. John Eagles of the Royal Cornhill Hospital in Aberdeen. Eagles believes that the virus that causes polio can also influence the onset of schizophrenia. Moreover, he believes that schizophrenia may be part of the post-polio syndrome.

Eagles bases his belief on the fact that since the mid-1960s. in England, Wales, Scotland and New Zealand, schizophrenia patients decreased by 50%. This coincides with the introduction of polio vaccination in these countries. In the UK, an oral vaccine was introduced in 1962. That is, when polio was stopped, the number of cases of schizophrenia decreased - no one imagined that this could happen.

According to Eagles, the Connecticut researchers found that patients admitted to the hospital with schizophrenia were "significantly more likely to be born during years of high polio prevalence."

Eagles also points out that among the unvaccinated Jamaicans who came to the UK, "the rate of schizophrenia is significantly higher compared to the local [English] population".

Eagles notes that in recent years, the existence of post-polio syndrome has been established. In this syndrome, about 30 years after the onset of paralysis, people begin to suffer from severe fatigue, neurological problems, joint and muscle pain, and increased sensitivity (especially to cold temperatures). Post-polio syndrome occurs in approximately 50% of patients with polio. According to Eagles, "The average age of onset of schizophrenia is approaching thirty years, and this is consistent with the concept of schizophrenia as a post-polio syndrome that develops after suffering a perinatal poliovirus infection."

Doctors David Silbersweig and Emily Stern of Cornell University believe that schizophrenics are unlikely to have serious brain problems, but, nevertheless, they managed to find something very interesting. Using PET, they developed a method for detecting blood flow during schizophrenic hallucinations. They conducted a study of six either untreated or untreated schizophrenics who heard voices. One had visual hallucinations. During the scan, each patient was asked to press a button with their right finger if they heard sounds. It was found that during hallucinations surface areas of the brain involved in the processing of sound information were activated. Moreover, in all patients there was a rush of blood to several deep areas of the brain: the hippocampus, hippocampal gyrus, cingulate gyrus, thalamus and striatum. Do schizophrenics really hear voices? Their brain data shows that this is the case.

The speech of schizophrenics is often illogical, incoherent and confused. It used to be thought that such people were possessed by demons. The researchers found a far less fantastical explanation. According to Dr. Patricia Goldman-Rakick, a neurologist, the speech problems of schizophrenics may reflect short-term memory failure. It was discovered that the prefrontal cortex of the brain of schizophrenics is significantly less active. This area is considered the center of short-term memory. Goldman-Rakick says, "If they can't hold on to the meaning of the sentence before they get to the verb or object, the phrase is devoid of content."

In addition to all of the above, there are many questions about schizophrenia that are still unanswered.

Is schizophrenia caused by maternal immune response or malnutrition?
Some scientists believe that schizophrenia is caused by damage to the developing fetal brain. A study conducted at the University of Pennsylvania, which involved medical data from the entire population of Denmark, showed that the occurrence of schizophrenia can be influenced by severe malnutrition of the mother in the early stages of pregnancy, as well as her body's immune response to the fetus.

Thanks for the memories
As the body ages, the enzyme prolyl endopeptidase increasingly destroys neuropeptides associated with learning and memory. In Alzheimer's disease, this process is accelerated. It causes memory loss and reduced active attention time. Scientists from the city of Suresnes in France have discovered medicinal compounds that prevent the destruction of neuropeptides by prolyl endopeptidase. In laboratory tests with rats that had amnesia, these compounds almost completely restored the animals' memory.

Notes:

Juan S. Einstein's brain was doing the washing // The Sydney Morning Herald. February 8, 1990. P. 12.

McEwen B., Schmeck H. The Hostage Brain. N. Y.: Rockefeller University Press, 1994, pp. 6–7. Dr. Bruce McEwan is head of the Hatch Neuroendocrinology Laboratory at Rockefeller University in New York. Harold Schmeck is a former national science columnist for The New York Times.

Interview with M. Merzenikh leads I. Ubell. Secrets of the brain // Parade. February 9, 1997. P. 20–22. Dr. Michael Merzenich is a neurologist at the University of California, San Francisco.

Lewis G., David A., Andreasson S., Allebeck P. Schizophrenia and city life // The Lancet. 1992 Vol. 340. P. 137–140. Dr Glyn Lewis and colleagues are psychiatrists at the Institute of Psychiatry in London.

Barta P., Pearlson G., Powers R., Richards S., Tune L. Auditory hallucinations and smaller superior gyral volume in schizophrenia // American Journal of Psychiatry. 1990 Vol. 147. P. 1457-1462. Dr. Patrick Bartha and colleagues work at the Johns Hopkins University School of Medicine in Baltimore.

Ainger N. Study on schizophrenics – why they hear voices // The New York Times. September 22, 1993. P. 1.

Shenton M., Kikins R., Jolesz F., Pollak S., LeMay M., Wible C., Hokama H., Martin J., Metcalf D., Coleman M., McCarley R. Abnormalities of the left temporal lobe and thought disorder in schizophrenia // The New England Journal of Medicine. 1992 Vol. 327. P. 604–612. Dr. Martha Shenton and colleagues work at Harvard Medical School.

Flaum M., Andreasen N. The reliability of distinguishing primary versus secondary negative symptoms // Comparative Psychiatry. 1995 Vol. 36. No. 6. P. 421–427. Dr. Martin Flaum and Nancy Andresen are psychiatrists at the University of Iowa Clinics.

Interview with P. McGuire leads B. Bauer. Brain scans seek roots of imagined voices // Science News. 9 September 1995. P. 166. Dr. Philip McGuire is a psychiatrist at the Institute of Psychiatry in London.

Bower B. Faulty circuit may trigger schizophrenia // Science News. September 14, 1996. P. 164.

Eagles J. Are polioviruses a cause of schizophrenia? // British Journal of Psychiatry. 1992 Vol. 160. P. 598–600. Dr John Eagles is a psychiatrist at the Royal Cornhill Hospital in Aberdeen.

The study by D. Silbersweig and E. Stern is cited by K. Leitweiler. Schizophrenia revisited // Scientifi c American. February 1996. P. 22–23. Drs David Silbersweig and Emily Stern work at Cornell University Medical Center.

The study by P. Goldman-Rakik is cited by K. Conway. A matter of memory // Psychology Today. January – February 1995. P. 11. Dr. Patricia Goldman-Rakic is a neurologist at Yale University.

Juan S. Schizophrenia – an abundance of theories // The Sydney Morning Herald. October 15, 1992. P. 14.

Research by J. Megginson Hollister et al. cited by B. Bauer. New culprit cited for schizophrenia // Science News. 3 February, 1996. P. 68. Dr. J. Megginson Hollister and colleagues are psychologists from the University of Pennsylvania.

Scientifi c American. Making memories // Scientific American. August 1996. P. 20.