Attacks of schizophrenia. How often can schizophrenia attacks Negative symptoms of schizophrenia

This form of the disease is characterized by the development of seizures of various psychopathological structures and the presence of remissions of a sufficiently high quality.

Recurrent schizophrenia occupies a marginal position in the classification of schizophrenia, adjoining affective psychoses. Therefore, it is sometimes called an atypical variant of manic-depressive psychosis, a third endogenous disease, schizoaffective psychosis, etc. It is brought together with a manic-depressive psychosis by a rather favorable course, the presence of pronounced affective disorders in attacks, with other forms of schizophrenia - the possibility of developing delusional and catatonic disorders.

The recurrent course of schizophrenia is characterized by oneiroid-catatonic, depressive-paranoid and affective attacks. Despite significant psychopathological differences, these attacks have much in common. In each of the types of seizures, affective disorders are present: manic, depressive, or mixed states. In attacks, the development of certain types of sensual delirium and even oneiroid stupefaction is possible. They may also have catatonic disorders. During the course of the disease, in some cases, seizures of various psychopathological structures occur, in others, the same type of seizures (cliché type) is noted.

A manifest attack usually occurs at a young age. The number of seizures in recurrent schizophrenia can be different. In some patients, attacks occur quite often, for example, every year or every 2-3 years, in other patients, there may be several attacks throughout their lives (in youth, presenile and old age). About 1/3 of patients generally endure only one attack. Seizures may occur at regular intervals. These episodes are often seasonal. Attacks can occur spontaneously, but sometimes the provoking moment of their development is somatic diseases, intoxication, psychogenia, in women - childbirth. There is a point of view that among patients with recurrent schizophrenia, persons of a hyperthymic circle with features of mental infantilism, without distortions and developmental delays, predominate; sthenic and sensitive schizoids are less common.

In the pre-manifest period, often long before the onset of the first attack, patients experience affective fluctuations that do not go beyond cyclothymic in intensity. They arise spontaneously, can be provoked by external factors, sometimes differ in seasonality. Due to their low severity, this kind of affective disorders often do not affect either the productivity or the working capacity of patients.

The initial period of the disease is characterized by general somatic disorders and affective fluctuations [Papadopoulos T. F., 1966] or phenomena of somatopsychic depersonalization with affective disorders [Anufriev A. K., 1969]. Periods of elevated mood with enthusiasm, a feeling of bliss, a desire for activity, a reassessment of one's personality are replaced by a low mood with lethargy, inactivity, exaggeration of the significance of small real conflicts, decreased activity, autonomic disorders. The resulting sleep disorders are characterized by unusually vivid dreams or insomnia. Periodically, patients have a feeling that something must happen to them, that they are going crazy (acute depersonalization).

Despite the noted psychopathological variety of attacks of recurrent schizophrenia, they differ in a certain pattern of development, expressed in successive stages of their formation [Favorina VN, 1956; Tiganov A. S., 1957; Stoyanov S. T., 1969]. They were described in detail by T. F. Papadopoulos (1966).

On the first of them, disorders of the affective circle appear; the second is characterized by the appearance of acute sensory delusions in the form of a staged syndrome and acute antagonistic delusions; the third is characterized by a state of oneiroid stupefaction of consciousness. If affective disturbances predominate in the structure of the attack, the attack is assessed as affective. If the syndromes of sensory delusions dominate, the attack qualifies as affective-delusional. The predominance of oneiroid is observed in the picture of attacks of oneiroid catatonia.

The development of sensual delirium in the picture of the disease against the background of low mood and the predominance of ideas of condemnation and persecutory disorders make it possible to assess the state as depressive-paranoid, the appearance of delusions of grandeur in the structure of acute fantastic delirium is evidence of acute paraphrenia.

In the onset of an attack, after a short period of affective disturbances and elated-ecstatic or anxious-depressed mood with a change in the perception of the environment (which looks either bright and festive, or gloomy and portends a threat), a stage of sensual delirium occurs, characterized by syndromes of staging and antagonistic delirium.

The staging syndrome is manifested by the feeling that arises in patients that a performance is being played around, a film is being shot; the gestures and movements of those around them are full of special meaning for them, and in the speech of those around them they catch a special, often only understandable meaning. Strangers seem to have been seen before, and acquaintances, relatives - strangers, disguised as relatives or relatives (a symptom of Capgras - a positive or negative double). At this stage, phenomena of mental automatism are also not uncommon: the patient says that his thoughts are known to others, other people's thoughts are put into his head, he is forced to speak and act against his will. Especially clearly psychic automatisms are found in patients who are not observers of the ongoing staging, but themselves participate in this performance. The movements of the patient are controlled, the words necessary to fulfill this role are prompted to the patient. Sometimes patients claim that the impact extends to all participants in the dramatization; the performance being played, in their opinion, is a puppet theater, where the words and actions of each "actor" are controlled and possible improvisation is completely excluded.

In the future, the syndrome of antagonistic delirium develops: in the environment, patients see persons who are representatives of two opposite and opposing groups, one of which acts as the bearer of a good beginning, the other - an evil one; patients feel they are at the center of the struggle. If these groupings reflect the confrontation of forces on the globe, in the galaxy, in space, it is customary to speak of acute fantastic delirium, the content of which, depending on the prevailing affect, turns out to be either expansive or depressive. In the structure of antagonistic and acute fantastic delusions, practically the same psychopathological disorders are observed as in the staging syndrome: delusions of special significance, sometimes persecutory forms of delusions, the Capgras symptom, and phenomena of mental automatism. If acute fantastic delirium is combined with ideas of grandeur, then there is reason to speak of acute paraphrenia.

With a oneiroid-catatonic attack of the next stage, there is a tendency to involuntary fantasizing with vivid ideas about travel, wars, world catastrophes, space flights, and this can coexist with the perception of the surrounding world and the correct orientation in the environment - an oriented oneiroid. Then oneiroid (dreamy) clouding of consciousness develops with complete detachment of patients from the surrounding fantastic content of experiences, modification and reincarnation of their I. The self-consciousness of patients changes or is more often deeply upset: patients are either loaded, completely detached from the environment and feel like participants in fantastic events that are played out in their imagination, - a dream-like oneiroid, or are confused, perceive the environment rather fragmentarily, are covered by bright sensual fantastic experiences abundantly popping up in their minds - a fantastically illusory oneiroid. Depending on the content and the predominant affect, an expansive oneiroid and a depressive oneiroid are distinguished.

Oneiric stupefaction, however, as well as the state of intermetamorphosis and antagonistic (or fantastic) delirium, is accompanied by catatonic disorders in the form of agitation or stupor. Dissociation is often possible between the appearance of the patient (lethargy or monotonous excitement) and the content of the oneiroid (the patient is an active participant in the events unfolding around him).

The stated pattern is characteristic of an acute attack with a high rate of development. However, quite often the development of an attack stops at one of its stages, and the symptoms characteristic of subsequent stages turn out to be only a short episode against the background of a protracted previous stage of the disease.

There are no fundamental differences in attacks of recurrent schizophrenia: the nature of each of them is judged by the predominance of affective disorders, sensory delirium or oneiroid in his picture, which is associated, as already mentioned, with the rate of development of the attack.

Along with oneiroid seizures and acute paraphrenia with fantastic delusions and ideas of grandeur, acute paraphrenic states can develop in recurrent schizophrenia, when delusions of grandeur occur outside the picture of acute sensory delusions; in these cases, the development of acute expansive paraphrenia with ideas of reformism and invention is possible. Some researchers, not without reason, regard this type of paraphrenia as one of the variants of a manic attack, that is, an attack of manic-depressive psychosis.

Acute paraphrenic states can develop during various attacks of recurrent schizophrenia, both affective and oneiroid-catatonic.

Depressive-paranoid attacks with anxiety, sensual delusions and the predominance of ideas of persecution and condemnation in his plot and a rather rare development of oneiroid episodes at the height of the attack are characterized by a tendency to a long course and stationarity of clinical pictures.

Affective seizures are distinguished by a lack of harmony in their development, a gradual increase in the intensity of affect and its lytic completion, the presence of mixed states, the rarity of the classic affective triad, greater variability of the clinical picture and the possibility of developing acute delusional episodes, dreaming and catatonic symptoms.

With the reverse development of attacks of recurrent schizophrenia, as a rule, affective disorders are observed: in some cases, high spirits with euphoria and ease of judgment, in others - depression with lethargy, apathy, hopelessness; at some patients alternation of polar affective frustration is noted. These conditions are often misunderstood as remission with personality changes.

The duration of attacks of recurrent schizophrenia is usually several months. Along with this, it is possible to develop short-term, transient states duration from several days to 1-2 weeks. [Kontsevoi V. A., 1965; Savchenko L. M., 1974]. Quite frequent and protracted, lasting for many months, and sometimes for many years, seizures, primarily depressive ones, which are distinguished by therapeutic resistance [Pchelina AL, 1979; Titanov A. S., Pchelina A. L., 1981].

During recurrent schizophrenia, two main options are possible: with different or the same type of seizures. The features of the course are largely related to the age of patients at the time of the onset of a manifest attack. At the age of 17-25 years, they are usually accompanied by the development of oneiroid-catatonic disorders; in subsequent attacks, their specific gravity and intensity are less pronounced, or the development of the attack stops at the stage of staging or acute fantastic delirium, and in the future the attacks are purely affective in nature with their inherent features. With the development of the disease at a later age, oneiroid-catatonic states in manifest attacks, as a rule, are not observed; more frequent are states with acute sensory delirium or attacks are affective in nature.

If the disease proceeds with the same type of attacks, then along with cases when all attacks during the life of the patient have a oneiroid-catatonic structure, one has to observe those in which the proportion of the oneiroid itself in each subsequent attack decreases. Often, within the framework of the considered variant of the course of the disease, from attack to attack, the unity of the plot of the patient's experiences is preserved (alternating consciousness, according to H. Gruhle). Such a feature of H . Weitbrecht (1979) noted with periodic catatonia.

Depressive-paranoid attacks more often than others tend to be protracted due to their therapeutic resistance, but they usually do not lose their severity. If the same type of seizures are purely affective in nature, then as the disease develops, they can become more atypical, dissociated and monotonous: in depression, lethargy and monotony predominate, in manias - foolishness and anger, in both, sensory delusions characteristic of attacks of recurrent schizophrenia may occur. .

In recurrent schizophrenia, both double and triple seizures can develop. In addition, there is also a course of the continua type, with a continuous change of manic and depressive states.

Remissions are of fairly high quality. Nevertheless, patients often have affective disorders of a cyclothymoid-like nature. Such disorders are usually similar to the manifestations that were in patients before the disease. Personality changes in recurrent schizophrenia either do not occur or are not as pronounced as in other forms. Sometimes they are manifested by special mental weakness and asthenia, which causes a decrease in the activity of the initiative and restrictions on contacts. At the same time, some patients have features of mental infantilism, manifested by the loss of independence, passivity, subordination; in others, one can note an overvalued, overly careful attitude to their mental health (they avoid strong impressions, situations that can injure their psyche), often become pedantic and rigid.

Symptoms and treatment of schizophrenia in children and adolescents

Schizophrenia is a mental illness that occurs in children, adolescents, and adults and is characterized by delusions, hallucinations, and personality changes. Symptoms of pathology in early age different from the manifestations of the disease in adults. To make a correct diagnosis, a psychiatrist must understand children's mental illness. Therapy is carried out with the help of drugs and psychological assistance.

Schizophrenia is a progressive mental endogenous disease that occurs in people mainly at the age of 20-23. This disorder is characterized by the presence of personality changes and other psychopathological disorders. Schizophrenia is characterized by a chronic course. Its severity varies from mild mental disorders to gross, up to a schizophrenic defect.

The exact cause of this disease has not yet been established. According to studies, schizophrenia in 79% of cases appears due to the presence of aggravated heredity. Intrauterine infections, the difficult course of pregnancy and childbirth also affect the formation of this disorder.

Scientists have found that schizophrenia most often affects people who were born in spring and winter. Traumatic brain injury, organic brain damage can lead to the development of this disease. The risk factors for schizophrenia include:

chronic stress;

childhood trauma;

anomalies in the structure and functioning of brain structures.

The main symptoms of schizophrenia include an associative defect, autism, ambivalence, and affective inadequacy (Bleyler's tetrad). An associative defect is characterized by a lack of logical thinking (alogia). Autism is a distraction of a person from the real and immersion in his inner world. The patient's interests are limited, he performs stereotypical (identical) actions and does not respond to external stimuli, does not communicate with people around him.

Ambivalence is characterized by the fact that the patient expresses opposite opinions regarding the same subject / object. There are three types of phenomena: emotional, volitional and intellectual. In the first form of ambivalence, the presence of an opposite feeling towards people, events or objects is noted. The strong-willed view is manifested in endless hesitation when solving a problem. The intellectual form of this disorder consists in the presence of opposing ideas in a person. The next group of symptoms is affective inadequacy, which is expressed in the patient's inadequate response to some events.

There are 4 groups of main types of signs of schizophrenia:

positive (productive);
negative (deficit);
cognitive (disorganized);
affective disorders.

Positive symptoms manifest as delusions, hallucinations, illusions, and psychomotor agitation. Illusions are an incorrect, distorted vision of an object that actually exists. Hallucinations are the occurrence of various simple (noises, sounds) and complex (scenes, actions) sensations (visual, auditory, olfactory, etc.), which do not actually exist. The most common are auditory, and visual are usually combined with olfactory and gustatory. Delusions are beliefs of a person that do not correspond to reality. The following forms are noted: persecution (someone watches the patient), influences (someone influences him from the outside, controls him), jealousy and greatness. Inappropriate behavior - actions of the patient that do not correspond to social norms. It includes manifestations of depersonalization and derealization. In the first case, this is a state of a person in which one's own thoughts and body parts seem not to be one's own, but brought in from outside. Derealization is characterized by excessive attention to minor, secondary signs subject.

Inappropriate behavior also includes catatonia - a group of movement disorders, which is characterized by the adoption and long-term maintenance of postures by the patient. When trying to change his position, the patient resists. Also, phenomena of inadequate behavior include hebephrenia - foolishness. Such patients are constantly jumping and laughing.

Negative symptoms diseases are characterized by the fact that with this disorder the qualities that should be in healthy people disappear. This group of signs includes a decrease in activity and a loss of interest in hobbies, poverty of speech and facial expressions, isolation. Emotional lability (sudden mood swings), impaired thinking and lack of motivation are noted.

When talking, patients constantly jump from one topic to another, and as the disease progresses, they stop performing self-service skills (brushing their teeth, taking a shower). There is a violation of concentration and memory. The judgments of such patients are predominantly abstract in nature (cognitive manifestations). Affective signs are characterized by a decrease in mood (suicidal, depressive thoughts).

The positive syndromes of schizophrenia include the following types:

The negative syndromes of schizophrenia include the following:

thinking disorders;
emotional disorders;
violations of the will (aboulia / hypobulia);
personal changes.

Disturbances of thinking are characterized by diversity, fragmentation and reasoning. At the first manifestation, minor events are perceived by the patient as important. The speech is vague, but the patient describes the details. Discontinuity is expressed in the preparation of a sentence from words and phrases that are not related in meaning, but grammatical basis yet true. In the patient's speech, a flow of vocabulary (verbal okroshka) is noted. Sometimes patients cannot finish their thought, because they constantly deviate from the topic or jump to another. In some cases, during a conversation, the thread of thought is lost. Reasoning lies in fruitless numerous arguments. In speech, patients use their own invented words (neologisms).

Emotional disorders are characterized by the fact that patients have coldness, cruelty and fading of reactions. Volitional disturbances are manifested in the form of apathy, lethargy and lack of energy. A person becomes passive and indifferent to the events taking place around him. Aboulia is total violations volitional sphere, hypobulia - partial. Depending on the course of the disease, personality changes develop, in which a person becomes withdrawn and mannered.

There are 4 main forms of this disorder: paranoid, hebephrenic, catatonic and simple. The first type is considered the most common. The leading symptom of this form of the disorder is delirium, and the emotional symptoms develop slowly.

Hebephrenic schizophrenia is characterized by antics, inadequate laughter of the patient and mood swings. There is a rapid change in personality. This disease appears at the age of 13 to 15 years.

In the catatonic form of schizophrenia, movement disorders occur. There is increased muscle tone. Patients discover the ability to copy the movements, phrases and facial expressions of the people around them.

The simple form is characterized by the absence of delusions and hallucinations. Patients refuse to work and study, for this reason there is a break in relations. This disorder appears in adolescence and adolescence. Patients become indifferent to the events taking place around them.

According to studies, the risk of schizophrenia in children and adolescents is 3-4 times higher than in adults. A schizophrenic defect at an early age is characterized by changes in the emotional sphere. Patients have a decrease in the brightness of feelings and empathy.

Children are characterized by cruelty to their loved ones and self-centeredness. Interpersonal relationships are superficial. A child may remain indifferent to the death of a loved one and cry over a broken flower. Children with such features of emotional life are characterized by a symbiotic attachment to one of the parents with dependence on him.

Autism manifests itself in the form of a departure from reality with a fixation on the inner world. Mental infantilism is characterized by the fact that the child is overly dependent on the mother. He has not formed age interests, a sense of duty and responsibility. Attractions in children appear with a delay. Sometimes mental immaturity is combined with physical immaturity, which is reflected in the small stature of the child and small facial features. Patients throughout their lives retain a childish expression, gait and facial expressions.

Mental rigidity manifests itself in the form of insufficient development and flexibility of such processes as emotions, thinking, behavior. There is a disturbance in the switching of attention. Such children hardly adapt to new conditions (kindergartens, schools or colleges). Patients can hardly endure a change in the usual environment (moving) or the regime of the day, the appearance and formation of contacts. The emergence of a new person in the house causes negative emotions and a reaction of protest. In sick children and adolescents, there is a decrease in activity. There is a decrease in the level of working capacity, lack of motivation to perform any action (apatoabulic defect).

The distortion of the patient's development is the more pronounced, the earlier schizophrenia occurred. There are two types of disturbances: disharmonic and delay mental development(ZPR). The first is characterized by a discrepancy between the maturation of mental and motor functions, i.e., there is an advance in speech and intellectual growth with a delay in motor growth. In some cases, the development of cognitive processes in the norm is noted when it is impossible to reproduce and assimilate household skills and self-service. Children have reasoning - pointless reasoning on any topic. There is asynchrony in facial expressions. Developmental distortion occurs after infancy. Speech is characterized by poverty and monosyllabicity. There is a violation of sound pronunciation, echolalia (repetition of the words of people around) and whispering. Patients sometimes imitate not only intonations, but also the timbre of the voice.

Children often refer to themselves in the third person. Their game is primitive and stereotypical (endless opening and closing of doors). The attention of such patients is distracted.

They become aggressive when distracted from activities. They do not communicate with peers and do not enjoy communication with other people. Children are unwilling and unable to dress and eat with their hands.

Symptoms of schizophrenia in adolescents are manifested various symptoms. Delusional thoughts are rare and have an unstable character. Patients have anorexia nervosa, dysmorphomania (the belief of a person in the presence of a physical defect), worldview disorders. In adolescence, paroxysmal forms of the course of schizophrenia predominate, but there are others that are observed in adult patients.

With a continuous sluggish illness, obsessive thoughts and affective disorders occur, against which negative symptoms progress in the form of impoverishment of emotions, gradual autism and a decrease in energy. The diagnosis established at this age is subsequently rejected, since a stable remission (absence of symptoms) occurs with various personality disorders. With unfavorably current delusional schizophrenia, the early stages of the disease fall on adolescence.

Patients develop malignant forms that proceed with motor excitation and lead in a short time to a deep schizophrenic defect. Stupidity, impulsiveness and negativism are noted. Patients have echo symptoms (repetition of movements, facial expressions and words of surrounding people), which alternate with immobility. Sometimes there are hallucinations.

Simple form of schizophrenia at this age is rare. Coat-like (paroxysmal-progredient) is characterized by the presence of obsessions, delusional, hallucinatory and movement disorders in patients. In the emotional sphere, depressive and manic disorders are observed. In the future, with this form, the development of personality changes occurs, which increase after each attack.

In recurrent schizophrenia, there is a periodic occurrence of affective disorders. After the 2-4th attack, personality changes occur, which mainly affect the emotional sphere of the patient. Depressive and manic disorders are noted. After one attack, a remission is formed with the presence of a chronic hypomanic state (small manifestations of an increased emotional background).

In childhood, the most common are fur-like and continuous forms of schizophrenia. Among the manifestations of this disease in children under 10 years of age, there are mainly no delusional disorders, hallucinations, and confusion. Phobias, movement disorders and psychosomatic pathologies predominate. Supervaluable hobbies and fantasies are noted. Malignant continuous schizophrenia is characterized by the presence in children of movement disorders, echo symptoms, freezing, impulsive behavior, and retention of urine and feces. Folly arises. With this variety, children after 1 year develop a severe defect in the form of mental retardation with catatonic (motor) symptoms and affective disorders.

Continuous sluggish schizophrenia develops slowly and gradually - from the very first months of life. With this form of exacerbation, they alternate with periods of normalization of the condition. There are psychosomatic disorders, tics, fears, enuresis (urinary incontinence), encopresis (fecal incontinence), stuttering, depressive and manic disorders. In all patients, the manifestations of schizophrenic defect are expressed in preschool age, but they develop puberty. Young children develop features of autism, from the age of 7 - emotional disorders. In prepubertal age, behavior is characterized by eccentricity, mental and physical infantilism is formed.

The productivity of activity in such patients is preserved, but activity is aimed at narrow circle objects. The closer adolescence, the more marked the restriction of interests. There is a decrease in activity, a slowdown in mental activity. Having reached puberty and adolescence, schizophrenic children are not independent, dependent on their parents, they need stimulation and control. Such patients graduate from high school worse than their peers. The choice of specialty is difficult because of the long rest breaks. Paroxysmal schizophrenia develops in patients over the age of 2 years. The presence of depressive, manic and delusional states is noted. There are pathological fantasies, fears and phobias. Each patient suffers up to 10 attacks that last 1-1.5 months. They are characterized by seriality, and between them there is a remission with affective symptoms and signs that are characteristic of neuroses. The duration of the break is more than 3 years, its beginning coincides with adolescence. Then a new psychosis occurs, the symptoms become more pronounced than before.

Sometimes obscurations of consciousness are noted. Delusional and hallucinatory disorders become more complicated. A schizophrenic defect in this form occurs after 1-3 attacks. Super-early (infantile) seizures are tolerated by patients in the period from 3 months to 1.5 years, i.e., in early childhood. The predominant symptom is somatic and vegetative disorders. This disorder is diagnosed on the basis of medical records of children's non-psychiatric institutions. It describes the condition of the child, in which there is a change in behavior, appearance, temperament and character. Seizures occur after a period of normal or advanced development with manifestations of an increased or even emotional background. They are associated with somatic diseases that the child has suffered. The main symptoms of this disorder are motor and affective disturbances.

Schizophrenic children have a cheerful or anxious mood background. Sometimes there is depression and detachment from the outside world. Depending on the mood of the patient, motor excitation or immobility appears, which is accompanied by an increase / decrease in muscle tone. In children, there is a monotonous cry of a paroxysmal nature lasting about 24 hours with breaks for sleep / feeding.

Anxious affect is manifested in the fact that children are afraid of strangers, household items, sounds. There are night terrors. There is increased tearfulness and constant readiness to cry. Patients develop stereotypical finger movements, body swaying, jumping, and head-banging on the bed. Sleep and appetite disturbances occur. The duration of rest is reduced, the period of falling asleep is increased. The dream becomes sensitive and superficial, children wake up from the slightest noise.

There is fatigue during the daytime and wakefulness at night. Frequent manifestations of superearly attacks are regurgitation, vomiting and diarrhea. Children refuse to eat or there is an increase in appetite. There are blanching skin, wrinkles on the forehead or near the mouth. The gaze of such children is fixed. There is a slowdown in development - both mental and physical. Then it happens at the same normal pace. Signs of hypomania occur after 2-3 months of the light period. From this moment on, the manifestations become stable and have an unchanged character. The absence of diurnal fluctuations in mood and depressive states is noted. Some children have repeated attacks at the age of 2-3 or 8-10 years. In this case, pathological fantasizing, an anxious mood arises. After their completion, the patient's affective symptoms persist.

Signs of a schizophrenic defect appear immediately after the first attack, but they range from subtle personality changes to signs of mental retardation. There is a developmental delay, which is characterized by difficulties in teaching the child in ordinary comprehensive schools. There are fears, emotional and motor disorders. Despite the insignificant depth of personality changes, children experience difficulties in adaptation in the first years of education. They do not communicate with classmates, are restless and conflicted. These manifestations force parents to consult a psychiatrist. As children grow older, school performance stabilizes.

Diagnosis of this disease is carried out by a psychiatrist and psychologist. It is important to collect an anamnesis from the side of the patient and his parents, which consists in the study of complaints and the causes that influenced the formation of schizophrenia. When examining a child, it is necessary to make sure that these manifestations have not arisen due to the patient's use of drugs and drugs.

The diagnosis is established on the basis of the presence of a progressive nature of the disease (gradual development of symptoms) and the occurrence of personality changes. To study the characteristics of the patient, they resort to the help of a psychologist who examines the patient through testing. Based on the diagnosis, a specific treatment is prescribed.

Treatment of schizophrenia is carried out in a complex way - with the help of medications and psychotherapy. Drugs can stop the symptoms, slow down the development of the disease and the schizophrenic defect. A feature of the therapy of adolescents and children is that the funds have a significant negative impact on the patient's body.

Juveniles with severe symptoms are treated in a hospital. In mild forms of this disease, therapy is carried out on an outpatient basis. Depending on the dynamics of the disease, the doctor may cancel the drugs. Funds are prescribed by a specialist, taking into account age, weight, type and course of the disease. Antipsychotic drugs are intended for patients with hallucinations and delusional disorders. Sleeping pills are prescribed to treat insomnia in patients. Sometimes antidepressants are used in the presence of depressive conditions. The most commonly used drugs are:

Psychology Library

Schizophrenia: symptoms and signs of the disorder in children and adults

Schizophrenia is one of the most common mental disorders, however, the causes of the disease are not so easy to identify. The symptoms and signs of schizophrenia are blurred, but modern diagnostic methods make it possible to make a more accurate diagnosis, which means that the patient receives more targeted and effective treatment.

How many types of schizophrenia are there?

In clinical form, schizophrenia has four forms of the disease, and each type has its own characteristics.

catatonic;
paranoid;
simple;
hebephrenic.

How many there are different types schizophrenia is hard to say. The Swiss psychiatrist Eugen Bleuler, who introduced the term "schizophrenia" into psychiatry, called this disease "schizophrenia", because of the ambiguity of symptoms and the variety of syndromes.

Diagnosis - paranoid schizophrenia: symptoms and signs in women

Paranoid schizophrenia in women occurs after 20-25 years. Symptoms and signs of the disorder are rarely pronounced, and it can take up to 10 years from onset to diagnosis. The main criteria by which the diagnosis of "paranoid schizophrenia" in women is made has several pronounced symptoms:

Dulling of emotions, or inadequacy of reactions to external stimuli.
Excessive suspicion, groundless jealousy, litigation, irritability.
Incoherent speech and violation of logical chains.
Loss of interest in work, hobbies, family and everything that used to be of value to a woman.

Most often, paranoid schizophrenia in women has a sluggish character, but behavior during exacerbation can change dramatically. Voices in the head compel the patient to compulsive actions, and no matter how unreasonable they may be, the patient cannot resist them. Voices in the head and hallucinations require immediate medical attention to avoid irreversible changes in the patient's psyche.

At such moments, jealousy, nervousness and suspicion are exacerbated in women. Reality is distorted, and one's own reflection in the mirror appears ugly and scary.

Most characteristic syndrome in paranoid schizophrenia, it is a persecution mania. It seems to a woman that everything that happens around is directed against her, or for her sake. Any event is a sign that she is being watched.

Paranoid schizophrenia is not always inherited. The disease is caused by a defect in several genes, but this only increases the risk of getting sick, nothing more. The probability of inheriting schizophrenia through the female line is less than 14%. The trigger for schizophrenia can be severe stress, or uncontrolled intake of psychotropic substances that women “prescribe” to themselves on the advice of their friends.

The main difference between the course of female and male schizophrenia is the perception of one's own "I". Women are prone to self-criticism and introspection. In schizophrenia with religious mania, women feel cursed, sinful, that they have been jinxed, and often they knock on the thresholds of churches or "fortune tellers" and "magicians" in search of healing. Men with this syndrome tend to deify themselves, and act as "saviors of mankind."

Complete remission in women with paranoid schizophrenia is possible, and 30% of patients return to their former lives. Another 30% can lead a conditionally normal life. With the right medication, in combination with social adaptation, a woman can return to her former life, start a family and successfully join the work team.

However, remission, that is, the absence of symptoms, does not mean that a person has completely got rid of the disease. Patients with paranoid schizophrenia need regular examination by a psychiatrist and timely therapeutic help, and also, stressful situations and overwork should be avoided, and close people should monitor this. After all, sometimes patients hide a new relapse so as not to injure the family again, thereby doing themselves a disservice. Paranoid schizophrenia requires specialist treatment, and self-medication is unacceptable.

Diagnosis - paranoid schizophrenia: symptoms and signs in men

Paranoid schizophrenia in men manifests itself more clearly, the symptoms and signs of the disease are more negative, that is, irreversible changes. Male schizophrenia is difficult to treat, and more often than not, full recovery is not possible. With timely treatment, it is possible to smooth out the symptoms and increase the time of remission, while maintaining a conditionally normal lifestyle.

Manifestations of paranoid schizophrenia in men:

How a man diagnosed with paranoid schizophrenia feels depends on the form of the disease. In general, the feelings of a patient with schizophrenia are similar to the feelings of a person who is in the stage of severe alcohol intoxication.

Difficulties arise with holding thoughts, with decision logical tasks and articulation of ideas. Speech disorder, memory lapses and sudden mood swings, all this is felt by a man with schizophrenia.

Often the patient is accompanied by phobias, but in paranoid schizophrenia, these phobias are devoid of emotions. The patient calmly talks about what he is afraid of, and often his fears are quite unusual. He says that his brain moves, and his head hurts, some letters scare him, and his nails grow ticklish.

Depersonalization - common concomitant symptom schizophrenia, and it changes the perception of one's own self. The patient feels that his personality is gradually being erased. He can't handle it, and it scares him.

In paranoid schizophrenia, short-term visual and auditory hallucinations are not uncommon. At the beginning of the disease, the patient hears someone calling him, talking to him, and over time, these voices transform into “voices in the head”, and instead of a dialogue, the patient hears orders from within that he cannot resist.

In depressive-delusional disorder, patients are seized by obsessive suicidal thoughts.

With hyperbulia, a patient with paranoid schizophrenia seeks to bring his ideas to life by all means. If the patient has persecution mania, during an attack he begins to actively look for "enemies", track them down and expose them.

In the case of an obsession with reforms and inventions, the patient knocks the thresholds of all possible instances with his proposals and innovations. He complains to all authorities about the non-recognition of his genius, and considers this all a world conspiracy against him.

Childhood schizophrenia: symptoms and signs of the disease

The main features of childhood schizophrenia are that boys are most at risk of developing schizophrenia. Two-thirds of all children with schizophrenia are males.

The childhood form of schizophrenia is difficult to diagnose. After all, each child develops differently, some children like to fantasize, others are silent and calm by nature. Children do not always share a fairy tale and reality. For them, toys are alive, they talk to them, feed them, make friends, and at a certain stage of development this is normal.

The manifestation of childhood schizophrenia is easily confused with children's pranks, and you need to be especially careful for those mothers whose children are at risk.

What you need to pay attention to:

hallucinations. Children's imagination can sometimes surprise, and not everyone can accurately determine whether a child has a hallucination, or is it a fantasy? You need to pay attention to the eyes of the child. If he follows with his eyes then what you do not see, listens to something, or talks to someone, this may be a symptom of schizophrenia.

Insomnia. Often children with schizophrenia sleep very little. They are lethargic, whiny, always tired, but sleep 4-6 hours a day. The child wakes up in the middle of the night, cries, but he cannot fall asleep again. Sudden fluctuations in activity, from running around and pranks, to complete exhaustion and loss of strength.

Alogia can be observed in children of primary school age. The child's thoughts are inconsistent, speech becomes confused and completely illogical. Alogia is the first negative symptom, and then regression follows, in which the child forgets everything that was learned earlier, and returns to the level of development of a one and a half year old child. Speech becomes poor, the answers are reduced only to “yes” and “no”, emotionality and interest in the old fun disappear.

Each symptom in itself means nothing, and the diagnosis of "childhood schizophrenia" is established on the basis of a whole set of tests and a general picture of the disorder noted over a certain period of time.

Schizophrenia in childhood and adolescence is difficult to diagnose, and in rare cases it is possible to detect the disease before the age of 7 years. Most often, if a child has a genetic predisposition to the disease, schizophrenia can make itself felt during puberty (12-15 years).

The disease manifests itself in the strange behavior of a teenager. The manifestation of schizophrenia is indicated by a set of symptoms inherent in this disease:

Foolish behavior and grimaces;
difficulties in communicating with peers;
sudden delay in learning;
delirium and incoherent speech;
impaired motor activity (catatonia);
auditory and visual hallucinations;
excessive emotionality;
fixation on one idea;
ambivalence.

In the case of adolescent schizophrenia, all these manifestations are more sharp shape. Children's psyche is more imperfect, and hormonal changes aggravate reactions to the limit.

The causes of childhood schizophrenia at an early age are due to several factors:

Late pregnancy of the mother;
viral diseases of the mother during pregnancy;
poor nutrition (diet, starvation) of the mother, during pregnancy;
hereditary factor;
severe stress;
violence.

If the disease is detected on time, then more than 60% of patients give favorable prognosis for childhood schizophrenia. Treatment of childhood schizophrenia is somewhat complicated by a very narrow range of permitted methods. Many drugs cannot be used by children, and due to their age, children do not perceive psychotherapy well. Up to a certain age, treatment is only symptomatic relief with sedatives, supportive care, and parental care. At this stage, the understanding of the parents is of great importance and is the key to the success of the cure. To understand the behavior of your child, regular consultations of parents with a psychiatrist are recommended.

Diagnosis - alcoholic schizophrenia: symptoms and signs of the disorder in men and women

Schizophrenia and alcohol addiction go hand in hand, and often alcoholism is the impetus for the development of schizophrenia. According to statistics, about 40% of patients with schizophrenia suffer from alcohol addiction. With alcoholism, the symptoms of schizophrenia are not so pronounced, and the onset of the disease can be missed. After all, anxiety and nervous tension are smoothed out under the influence of ethanol, and inappropriate behavior can be attributed to alcohol intoxication. But this is only the first time.

With alcoholic schizophrenia in men and women, the disease can proceed in a rapid form, and irreversible disintegration of the personality occurs in a matter of months. Alcohol accelerates the development of mental illness, and this disease, in turn, provokes the need for alcohol.

Continuous alcoholic schizophrenia is characterized by: initial short attacks, with long periods of remission. But the further, the attacks become more frequent, deeper and occur regardless of the intake of alcohol.

Schizophrenia never comes suddenly. At the very beginning of the disease, it is with alcohol that they want to relieve tension, and they do not notice changes in the psyche, attributing everything to stress and fatigue. The patient himself does not notice how the disease gradually erases the boundaries of reality. Delirium, and visions, which used to attack only after taking alcohol, eventually do not let go even on a sober head. The patient becomes aggressive, and may be a danger to others.

Against the background of alcoholism in men, libido is weakened, but schizophrenia exacerbates sexual desire. Due to the inability to fulfill their desires, the patient develops jealousy, aggression, and it spills over to the opposite sex.

Alcoholic schizophrenia stands apart from other types of schizophrenia, since the destruction of the psyche is provoked by toxins that enter the patient's body from the outside. The treatment of alcoholic schizophrenia is primarily aimed at the speedy removal of toxins from the body and the restoration of normal brain activity with a whole range of individually selected drugs.

Diagnosis - latent schizophrenia

Latent or latent schizophrenia, what is it, and how big is the risk of developing overt schizophrenia?

Latent schizophrenia is diagnosed only on the basis of anamnesis of the disease. Not always latent schizophrenia progresses and becomes apparent. Signs of latent schizophrenia are often attributed to eccentricities and a kind of protest against the rules and the system. Previously, this diagnosis was given to dissidents, hippies and other outcasts.

Today you can see eccentric individuals who dress strangely, are covered with tattoos from head to toe, or behave in a way that is not accepted in society. They have strange passions and hobbies that cause misunderstanding or rejection of society, but this is not considered a painful condition.

Some people with schizoid disorder have a very high level of intelligence, and reach heights in their field of activity, however, due to the disharmony of emotional development, the socialization of the individual is difficult.

Such "rebels" are diagnosed with latent schizophrenia, but, as a rule, this is attributed to mental disorders, for which psychocorrection is indicated, and not drug treatment. Deviations can concern not only the appearance, but also the behavior of the individual. Social isolation, obsessions, emotional coldness that does not develop into psychosis, and the person is simply considered "weird".

Often a person with this disorder is considered an egoist. However, lack of empathy is not a character trait, it is a clear sign of a disorder, and a lack of a sense of humor is also a characteristic feature of latent schizophrenia.

Latent schizophrenia is characterized by small personality deviations, with the absence of obvious psychoses and neuroses, which are an indispensable attribute of nuclear or paranoid schizophrenia. Hallucinations and delusions, with latent schizophrenia, are absent, or are of a shallow nature, more similar to a dreamy state.

The latent form of schizophrenia can develop into an explicit one, under certain conditions:

hereditary predisposition;
traumatic brain injury;
psychological trauma;
intoxication.

Of the literary characters, the most prominent representative of a patient with a latent form of schizophrenia is the hero of Arthur Conan Doyle's novels, the well-known detective Sherlock Holmes. Many admire him, however, if you analyze the psychological portrait of the character, you can immediately see the emotional coldness, megalomania, obsession with his ideas and social phobia.

The character has virtually no friends, and the character's sibling exhibits the same traits, suggesting a hereditary disorder. At the same time, both brothers have a high level of intelligence, but an extremely narrow range of interests.

AT new edition There is no diagnosis of "latent schizophrenia" in the International Classification of Diseases, and this disorder is referred to as schizoid personality disorders. The treatment of this disorder is difficult due to the patient's low level of empathy and lack of motivation. The patient himself does not consider himself as such, and sometimes even takes pride in his exclusivity.

Diagnosis - hebephrenic schizophrenia

If psychiatrists have disputes about the nature of the occurrence of hebephrenic (hebephrenic) schizophrenia, then the provoking factor is beyond doubt.

As a rule, hebephrenic schizophrenia appears in dysfunctional families in which children experience constant stress and poor, unbalanced nutrition. About 80% of patients with hebephrenic schizophrenia have clear signs malnutrition and underweight.

AT countryside this diagnosis is less common than in large cities, which indicates a dependence on living conditions. In large cities, children experience more stress, and, possibly, the negative environmental situation affects.

The disease manifests itself in adolescents over the age of 14, and is fully formed in 3-4 years. At the beginning of the disease, isolation and difficulties in communicating at school are observed. At the same time, attachment to relatives, especially to the mother, increases. The ridicule and bullying of peers lead to self-isolation and isolation of a teenager.

Thinking narrows and there is a gradual decline in intelligence. All hobbies and conversations are of a primitive nature, corresponding to the level of a small child. Mannerism, antics, foolishness appear, and outwardly the patient's behavior looks like a bad actor.

Any criticism of the patient causes aggression, or tears. Also abruptly the patient can go from tears to laughter. Mood swings are reactive.

Short periods of hallucinations and delusions are not profound and do not significantly affect the patient's behavior. As a rule, at these moments the patient separates reality from delirium.

Over time, the patient has an increased sexual desire, which, due to their disease, they cannot satisfy. There may be obscene behavior, accompanied by antics and laughter.

The very name of the disorder comes from the name of the ancient Greek goddess Hebe, who embodied eternal youth and pranks. Patients with hebephrenic schizophrenia are almost adults, but with the mind of a child. With this disease, development stops, the process goes in the opposite direction, and the patient slowly degrades.

The difficulty of hebephrenic schizophrenia is that it is continuous, and there is no remission period when the patient can lead a normal life.

Catatonic form of schizophrenia

The catatonic form of schizophrenia is quite rare, and this disease affects not only the intellect, but also affects the psychomotor functions of a person. Catatonia is manifested by more than 20 symptoms and some of these symptoms are non-specific. These symptoms are united by the frequency of stupor and arousal.
Symptoms of catatonic schizophrenia include:

catatonic stupor

The patient freezes in place, even in an uncomfortable position and does not respond to external stimuli. Often at this moment the patient sees fantastic visions in which he himself takes a direct part, and after an attack, maybe even vividly describe the events he experienced. In a catatonic stupor, the patient can be from several hours to several days. The muscles at this moment are so tense that there is no way to bend or straighten the limbs. Quite often from a motionless posture and a long lying, bedsores appear.

Wax flexibility

The body of the patient becomes obedient and plastic. If a lying patient raises his arm, leg, head, they will remain in this position. The pulse and breathing of the patient slows down, and becomes almost imperceptible.

Negativism

The form of paradoxical negativism disorder is characterized by the fact that the patient performs the exact opposite action in response to a request. With active negativism, the patient resists requests and does anything, but not what he is asked to do. Passive negativism is characterized by resistance to action. If you try to change clothes or feed such a patient, he will silently resist.

stereotype

The tendency to automatically repeat the same phrases or actions. Rocking, marching, tiptoeing, scratching, tapping, etc. With stereotypy, this repetition can last for several hours in a row. The patient does not respond to the voice, and requests to stop the action.

The patient's speech functions work, however, he refuses to make contact and does not give out anything that he hears and understands the interlocutor. With Pavlov's symptom, the patient responds only to whispering.

Catatonic stupor with delusions and hallucinations is regarded as a malignant form of schizophrenia. At risk are creative people, with a clear craving for perfectionism and the syndrome of an excellent student. Continuous nervous tension, striving for the ideal can lead to catatonic stupor, stereotypy, with a rapid deterioration in the patient's condition, up to febrile catatonia.

Latent form of schizophrenia

The latent form of schizophrenia is difficult to diagnose, due to the lack of obvious symptoms that are inherent in schizophrenia. The signs in men and women are almost the same, and it is quite difficult to recognize the presence of the disease, even for close relatives. Latent schizophrenia has a chronic course, without deep personality changes. In the international classification of diseases, the diagnosis of "latent form of schizophrenia" is absent, and the entire set of symptoms is attributed to schizotypal personality disorder.

How does latent schizophrenia manifest itself?

Symptoms of a latent form of schizophrenia are often referred to as a depressed mood or loss of energy. However, if there is a certain cyclical nature of such depression, you should pay attention to other symptoms characteristic of this disorder:

Impoverishment of speech. This concerns the difficulties of constructing complex sentences and the lack of emotional coloring. Speech becomes monosyllabic, monotonous and inexpressive.

Violation of verbal contact. It is difficult to make eye contact with the patient. He does not look into the eyes, his gaze wanders or freezes in place. The patient's facial expressions and gestures are absent, and it seems that the patient does not hear the interlocutor.

In movements, you can notice a certain inhibition and uncertainty. The appearance of the patient becomes repulsive, due to indifference to hygiene and appearance. The patient loses the purpose in life, and paradoxical ideas and thoughts arise in his head, sometimes contradicting each other. Decreased or completely lost sexual activity. The patient withdraws into himself, and the emphasis also shifts. He is not interested in the world, people and events, but he is acutely experiencing his own problems.

Latent schizophrenia is sometimes confused with neurosis, or apathy, since the manifestations of these diseases are similar. However, schizophrenia can progress, and at the slightest suspicion of this disease, one should turn to good specialist. The diagnosis is made on the basis of the general picture of observation of the patient. Often, it takes 2 months or more to accurately diagnose latent schizophrenia, due to the fuzziness and blurring of symptoms.

Latent schizoid disorder is thought to be due to difficulties in social interaction. Withdrawal into yourself and your fantasies is a defensive reaction of the brain. After all, in your fantasies you can afford anything. You can be bold, courageous and popular, which in real life not everyone can achieve.

senile schizophrenia

Schizophrenia in old age occurs quite rarely, as a rule, manifestations were in adolescence or later, but they were not paid attention to at the time. Of course, people of any age are not immune from schizophrenia, but if a patient did not have schizophrenia before the age of 60, then the chances that this will happen are extremely small.

With small deviations in behavior, a thorough examination should be carried out to identify other causes of damage to the central nervous system.

Approximately 2/3 of patients with senile schizophrenia are single women, and they are at risk.

Symptoms and signs of late schizophrenia in the elderly:

Protracted depression, with complete social isolation;
visual hallucinations;
auditory hallucinations;
suspicion;
cognitive impairment.

How does senile schizophrenia manifest itself?

The course of the disease in the elderly is often complicated by the extinction of the sensory sphere. They hear, see, feel worse, and against the background of schizophrenia, the sick brain itself builds and thinks out images that transform into hallucinations based on the patient's fears.

Older people are prone to a paranoid form of schizophrenia. It seems to them that they are being persecuted, robbed, or their own relatives or neighbors want to bring them to the grave. Sometimes they themselves call the police, an ambulance and accuse neighbors or relatives of trying to kill them. At such moments, it is desirable to maintain composure and the contact number of the attending psychiatrist. At severe form senile paranoid schizophrenia is characterized by a continuous course of the disease, without remission.

It can be difficult for loved ones to cope with such a disease, and in some countries it is practiced to relocate the patient to a special institution, where he is provided round-the-clock assistance and care. The treatment of senile schizophrenia is complicated by the mass of side effects from antipsychotics. Elderly people often suffer from cardiovascular diseases, which is why many drugs are contraindicated for them. In addition, older people tend to trust their own experience than young doctors, and often "prescribe" medications themselves, which leads to more complications.

Diagnosis and treatment of schizophrenia. How to deal with disorder?

There are no 100% tests for schizophrenia. Many mental illnesses have fairly similar symptoms, and it is important not to make a mistake with the diagnosis. Each disorder requires specific treatment, and misdiagnosis can be costly to the patient.

Diagnostics

Methods for diagnosing schizophrenia include a comprehensive examination of the patient. Schizophrenia affects the frontal and temporal lobes of the brain. Neurons die and the MRI clearly shows a decrease in the lobes of the brain, an increase in the ventricles, or changes in the structure of the brain.

The brain anomaly itself does not indicate schizophrenia, and the disorder may be due to infection, trauma, or genetic feature. There is no evidence that shows with certainty what is the cause and what is the consequence of the pathology. At structural changes brain, schizophrenia is partially reversible. The hippocampus (the department responsible for emotions, memory, attention) can be partially restored with the help of physiotherapy.

Genetic blood test for karyotype. To date, it is impossible to change the genes, but they are well enough studied to speak about the accuracy of such a study. According to these studies, in 100% of patients with schizophrenia, changes were observed in 6, 8 and 13 pairs of chromosomes. Such an analysis is done once in a lifetime, since genes do not change with age.

In healthy people, pathologies in these pairs of chromosomes can also be observed, and these changes indicate a predisposition to the disease, but do not confirm its mandatory appearance.

Neurochemical analysis. Certain types of schizophrenia arise due to metabolic disorders. Some physicians deny the dopamine theory of schizophrenia, however, the level of dopamine and serotonin in patients with schizophrenia is quite high. It has also been noted that improper functioning of neurotransmitters can cause hallucinations similar to those experienced after taking drugs.

Neurophysiological test for schizophrenia. In schizophrenia, there is a disorder in the reception of a signal by the eyes, its transmission to the brain and feedback, which is responsible for the reaction to a light stimulus. During the test, the patient is asked to follow the beam of light with his eyes. Normally, in a healthy person, eye movement is smooth, without pauses and delays. In patients with schizophrenia, eye movement is delayed, with frequent pauses and errors. Diagnosis of schizophrenia by a neurophysiological test is 70 to 90% accurate. Such a wide spread is given by world statistics, which also established that impaired visual smoothness in some peoples is a racial feature.

Electromyography. A feature of patients with schizophrenia is mild facial expressions. Some even wonder why schizophrenic patients look younger than their years? It's a matter of mime. Only with hebephrenic schizophrenia is the patient mimically active, other forms of schizophrenia are characterized by mimic immobility, and mimic wrinkles do not appear from this.

Emotions are present, but the bioelectrical work of the facial muscles is disturbed. Internally experiencing emotions, the patient cannot frown, smile, or somehow express emotions with facial expressions. Electromyography, on the other hand, shows a change in temperature and sensitivity of the skin of the face, during test screenings of provocative films.

Differential diagnosis of paranoid schizophrenia

Schizophrenia is characterized by many syndromes of various nature. To make a more accurate diagnosis and quality treatment, the method of differential diagnosis is used. In this case, the symptoms are recorded in the disease card, and by the method of elimination they go to the main goal - the diagnosis. Intoxication with alcohol or drugs, neuroses and other disorders should be excluded.

Previously, with a diagnosis of schizophrenia, complex treatment was carried out, which included drugs for hallucinations, delusions, autism, spasms, and much more. This did not give the desired effect, and schizophrenia was considered a sentence for the patient. Now, differential diagnosis does not consider schizophrenia as a single disease, and this approach to the disease gives a longer diagnosis, but effective and high-quality treatment.

Diagnosis of childhood schizophrenia

In childhood, the diagnosis of schizophrenia is difficult due to the lack of specific symptoms. However, it is chronic and progressive in nature, which is why it is so important to diagnose it in time. Diagnosis in children is based on observation of the development of the child, and changes in development.

At an early age, schizophrenia has some symptoms to look out for:

The child is lethargic. He doesn't play with toys, doesn't watch cartoons, and games with peers don't appeal to him.

Increased anxiety, tearfulness and suspiciousness. The child is afraid of literally everything and tries to hide in his room, or does not get off his mother's arms.

Frequent mood swings, excessive emotionality. Helplessness. The child cannot take care of himself. He does not know how to use cutlery, the toilet, and cannot dress himself.

All these symptoms should be considered only in dynamics. If earlier the child developed normally, and these symptoms appeared suddenly, or have some kind of cyclicity, you should immediately contact a specialist.

Adolescents may experience a hebephrenic form of schizophrenia, which is sometimes confused with promiscuity and permissiveness. The teenager grimaces, laughs out of place, while there is an obsession only with himself and his interests. Sometimes they are carried away by some idea, and they are not able to think about anything else.

With sluggish schizophrenia, a teenager becomes unemotional and apathetic. Often, with schizophrenia, there is a violation of motor skills, which is manifested in awkwardness of movements, angularity, and difficulty in performing written tasks and holding objects in the hands.

Diagnosis of schizophrenia by the perception of phraseological units is the most accurate. In schizophrenia, the perception of figurative and abstract thinking mainly suffers. The patient is not able to think out the image, and understands the words literally. In the case of phraseological units, the words themselves do not carry a literal meaning, which makes it difficult for translators into foreign languages. There is no literal and literal meaning, but the allegorical moment is of great importance. If you ask a patient with schizophrenia to explain the meaning of phraseological units: “Stay with your nose”, “Not for Senka's hat”, “Not for horse food”, etc., he will have difficulties with this.

The same goes for visual tests. When showing the patient optical illusions, 3D pictures, the patient will see only a flat image, even if it is illogical and incorrect. The brain of a healthy person itself completes the missing parts of the picture, or “straightens” the distortions, making the picture correct, but in schizophrenia, this ability disappears.

Patients with schizophrenia are rarely aggressive. Most often, aggression is observed in alcoholic schizophrenia or in patients with a low level of intelligence. But patients can harm themselves or others during an exacerbation of the disease. At the time of hallucinations, with a paranoid form of schizophrenia, the patient may mistake physicians or relatives for enemies, and the self-defense mechanism is activated.

Do people with schizophrenia understand that they have a mental disorder?

It is worth mentioning here that schizophrenia is cyclical, with relapses and remissions. During the period of remission, as a rule, the patient is aware of his disease, and makes contact with the doctor. Some patients may even anticipate an attack of schizophrenia, and try to protect themselves and loved ones from the manifestations of the disease. They block bank cards, run away from home, or manage to notify relatives to call a doctor, or look after the house while they are gone. Without appropriate treatment, this understanding of their illness is lost over time, and the patient is acutely aware of his "normality", blaming those who disagree with him for mental illness.

Many scares mental disorder, and the patient prefers not to know about his diagnosis, however, this is in vain. You should forget black and white films about psychiatric hospitals, they remained only in the cinema. Modern clinics are equipped with more advanced diagnostic equipment, and schizophrenia is a fairly well-studied disease. Self-diagnosis of schizophrenia is unacceptable, and this diagnosis is established only by a psychiatrist.

Treatment of patients with schizophrenia in last years seriously moved forward. A new generation of drugs has been developed that is more targeted and acts directly on a specific symptom. Treatment of schizophrenia with new generation antipsychotics minimizes side effects, and they quickly relieve the exacerbation of the disease.

For various syndromes, psychotropic drugs are used for different purposes. The main purpose of neuroleptics is to block dopamine, noradrenal and serotonin receptors, and normalize their activity, until the symptoms disappear completely.

Delusional disorder is well removed by triftazin, and haloperidol removes hallucinations. With motor excitation, chlorpromazine or azaleptin are indicated. Disinhibits catatonic disorder rispolept, fluanxol, eglonil. Productive symptoms in the paranoid form of schizophrenia are relieved by haloperidol, triftazin, azaleptin, fluanxol, or rispolept.

Sluggish schizophrenia also sometimes requires treatment with antipsychotics, but with a milder effect: neuleptil, sonapax, truxal, and the like.

In clinical depression, with all sorts of obsessions, antidepressants are prescribed: amitriptyline, anafranil, melipramine. In severe form, antidepressants alone cannot cope and require the addition of antipsychotics of depressogenic properties: rispolept, triftazin, quetiapine, olanzapine.

Progressive schizophrenia, in the absence of treatment or with improperly selected drugs, will certainly lead to a schizophrenic defect, in which there is an irreversible destruction of the psyche.

With a continuous course of the disease, during treatment with antipsychotics, addiction to the drug may occur and side effects may develop, mainly affecting motor activity, similar in symptoms to Parkinson's disease. There are muscle spasms, muscle stiffness, trembling in the hands, etc. To eliminate these manifestations, akineton, cyclodol, or diphenhydramine is used.

Antipsychotics are indicated for an acute attack, and each time the dose is carefully calculated based on the severity of the attack and the physiological characteristics of the patient. Immediately after the relief of an acute attack, the dose of neuroleptics is reduced, supportive therapy and psychotherapy are introduced.

Treatment of mild schizophrenia without antipsychotics

The mild form of schizophrenia implies a continuous, protracted nature, in which there is no delirium, and no hallucinations. The patient's mood decreases, interest in life fades and social isolation develops. This disorder does not involve the use of antipsychotics, except when neuroses appear.

Modern methods of treatment of schizophrenia

It is believed that in the treatment of a mild form of schizophrenia, a vegetable diet helps well. Of course, this diet must be balanced and provide the body with the necessary elements. In case of a lack of vitamins, the diet should be supplemented with complex vitamins and dietary supplements. However, even mild schizophrenia cannot be cured by diets alone, and this is only aid. In most cases, antidepressants and normomitics are required to correct behavior and improve mood.

Innovative stem cell treatment for schizophrenia produces amazing results. In some cases, the course of the disease can be alleviated, or even get rid of this disease.

Stem cells are capable of self-renewal and recovery, and it is this property of theirs that is used to restore the dopamine system and the hippocampus, instead of dead brain cells. So far, there are not many clinics in the world where stem cell treatment is carried out, and the decision on this method is made jointly by the patient and the attending physician. Before this, it is necessary to achieve a stable remission, with the help of neuroleptics, and stabilize the patient. The downside of stem cell treatment for schizophrenia is only the price of these procedures and time.

Psychocorrection

Psychocorrection is indicated during the period of remission and is aimed at alleviating the patient's condition. Often, it is internal conflicts that lead to an attack. The task of the psychologist in this case is to identify this internal conflict, and together with the patient to find a solution.

Treatment of schizophrenia with folk methods

For many people, being in a hospital is stressful, especially in a psychiatric hospital. In schizophrenia, stress is contraindicated, and most psychiatrists try not to keep patients in the clinic for more than three weeks in a row. Immediately after stopping the attack, the patient is sent home under the care of relatives, if they are ready for this. After all, the patient needs care, and compliance with a certain regimen. You should completely give up smoking and alcohol.

Make a clear schedule for eating and walking. Ensure the patient receives only good news. This means that you need to watch what the patient watches on TV and reads.

As maintenance therapy, it is worth paying attention to medicinal herbs. Many of them have quite strong action, and it is worth consulting with your doctor about their use. Comfrey grass - relieves hallucinations.

Reseda relaxes and removes aggression. Oregano helps with tremors of the limbs and soothes. For general strengthening body, you can make tea from blackberry leaves and hops.

Do not think that herbal decoctions are just a harmless tea. If the patient is taking antipsychotics or other prescription drugs, herbal teas may increase or decrease the effect of the medication. In any case, when treating schizophrenia at home, it is necessary to consult a doctor about the use of even vitamins, or exotic foods.

Alternative Treatments for Schizophrenia

Alternative treatments for schizophrenia will not replace full-fledged drug treatment. It may relieve the condition of the patient somewhat, but will not cure the severe form of the disorder. It would be wiser to consider these methods as auxiliary, but nothing more.

The most common and well-known method is the “Tibetan way”. Since schizophrenia is a disease of the mind and body, it is necessary to treat the soul and body at the same time. Pour into an earthen vessel vegetable oil(olive, corn, sunflower, etc.), seal the vessel, and bury in a quiet place for 12 months.

After this time, the vessel is dug out and several courses of massage are carried out using this oil. The atmosphere at this moment should be calm, relaxed and peaceful. They massage the shoulders, neck and head, implying the redirection of the flow of energy in the human body.

Of course, massage will not relieve an attack of schizophrenia, but as a tonic and relaxing remedy, massage is very effective, and there will be no trouble from it. Massage relieves muscle spasms, and faith in a miracle can really work wonders.

Running, swimming, hardening - all this strengthens the body, accelerates the blood, and does not give time for soul-searching, depression and despair. The human body is capable of self-healing and self-healing within certain limits. Playing sports disciplines the patient, increases blood circulation and increases oxygen saturation of the brain.

There is a theory that schizophrenia attacks are caused by improper breakdown of adrenaline, and when playing sports, adrenaline does not accumulate, therefore, remission occurs.

Treatment prognosis for schizophrenia is mixed. Great value has a form of schizophrenia, age, sex of the patient and neglect of the disease. Some types of schizophrenia are resistant to drugs, and the development of the disease can only be slightly suspended, and the patient's condition can be slightly alleviated.

Women after treatment are easier to adapt to society. They trust psychotherapists more, more clearly follow all the prescriptions of doctors, and as a result, their chances for a normal life increase.

Men are more secretive. After a single treatment, they consider themselves completely healthy, and hide the onset of the next attack, aggravating the disease. They are ashamed of their illness and rarely turn to psychotherapists for help, preferring to isolate themselves from the whole world. Deep experiences in schizophrenia do not allow you to recover, and in this regard, the chances of a normal life after a course of treatment are extremely small.

Childhood schizophrenia has its own characteristics. Before the onset of physiological maturity, children receive small doses of drugs based on the symptoms of the disease, in microscopic doses. Classes with a psychologist should be regular and it is more reasonable to send the child to a correctional Kindergarten, or school. It is impossible to lock the child at home, or punish him for his illness, otherwise, when the time comes for serious treatment, the child's psyche will be too damaged, and for full life he can no longer count. Parents should be patient if they value the happiness and health of their child.

The microclimate in the family is of great importance for the recovery of the patient. If the patient is surrounded by care and love, relatives understand him - the chances of returning to normal life are doubled. In dysfunctional families, the patient does not have such chances, and most likely, he will be a frequent patient in a psychiatric clinic.

Modern antipsychotics do not cause dependence, however, many are sure that these drugs turn them into "zombies" and make them dependent on drugs for life. This is not true. When treated with new generation antipsychotics, about 60% of patients achieve stable remission. Relapses are less frequent, and remission time is increased. In some cases, the patient has to take antipsychotics for life, and this should only take place as prescribed by the attending physician.

According to psychiatrists, schizophrenia is a disease of civilization and big cities. In small, traditional communities, schizophrenia is virtually non-existent. It is noted that in rural areas and small towns, even in the presence of genetic anomalies, schizophrenia is less common. People in small towns are physically stronger and more resistant to stress, and stress is the trigger for schizophrenia.

Schizophrenia after treatment dictates its own rules. After all, this is a chronic disease, and it can return at any time. It is impossible to insure against this, and loved ones must be prepared for this lifelong struggle. The human psyche is extremely fragile, but if you are not afraid of the disease, resist it and follow all the recommendations of doctors, schizophrenia can recede. A person can enjoy life, with joy, not fear, look into the future and make plans for tomorrow.

Periodic (recurrent) schizophrenia

The recurrent form of schizophrenia occurs in the form of attacks with a wide variety of durations (from several weeks to several years). The number of attacks in patients during their lives is different - from 1-2 to 10 or more. In some patients, each attack is provoked by an exogenous moment (symptomatic lability). There are three types of seizures characteristic of recurrent schizophrenia. These include oneiroid-catatonic, depressive-paranoid and affective seizures. It is not possible to single out one or another variant of recurrent schizophrenia depending on the nature of the seizures due to the fact that most patients experience seizures of various psychopathological structures during their life. Attacks as a whole are characterized by bright affectivity, one or another type of sensual delirium, catatonic disorders quite easily arise. Remissions are of high quality. The absence of changes in the patient's personality after the first attacks allows us to speak of intermissions. Gradually, after repeated attacks, patients experience personality changes, which are characterized by the following manifestations: asthenic, hypersthenic, with an increase in working capacity, but with a decrease in creative efficiency and a slight impoverishment of emotional manifestations. Usually these changes are observed after the third - fourth attack. Then the activity of the process decreases: seizures become less frequent, personality changes, as it were, freeze at the same level. One of the important features of patients suffering from recurrent schizophrenia is that they always have a critical attitude to the psychotic state they have experienced and they clearly distinguish between the state of health and illness.

The performance of such patients usually does not decrease, with the exception of a slight drop in patients with asthenic personality changes. The prognosis for recurrent schizophrenia is quite favorable, but it should be borne in mind that in such patients, against the background of severe depression, suicidal thoughts and attempts are noted. These patients require special monitoring.

paroxysmal schizophrenia

This form is characterized by recurring attacks against the background of a continuously ongoing process, which manifests itself in productive and growing negative symptoms.

Attacks in this form of schizophrenia are diverse, characterized by extreme polymorphism and unequal duration (from "transient", lasting minutes, to stretching for many years). However, they are less acute than attacks of recurrent schizophrenia; paranoid and hallucinatory manifestations have a greater proportion in their structure. Sometimes productive symptomatology in paroxysmal progredient schizophrenia is observed not only in attacks, but also in the intercritical period, increasing deficient personality changes, residual (residual) symptoms of an attack are revealed. The structure of seizures in this form of schizophrenia is polymorphic. For example, in a manic attack, the patient often "intersperses" depression in the form of ideas of self-blame, tearfulness, etc. An incomplete critical attitude to the transferred state is characteristic, even in cases where the attack was characterized by severe and massive psychotic symptoms, and sometimes it is completely absent .

The age of onset of paroxysmal progressive schizophrenia also varies. It can begin in childhood, adulthood, and late age. Depending on the age period in which the disease begins, age-related features are clearly manifested in the clinical picture. For example, the presence of infantilism in a patient allows big share confidence to talk about the onset of the disease in childhood. The prognosis for paroxysmal progredient schizophrenia is varied and depends primarily on the age of onset of the disease, the severity of the process and the degree of personality changes.

Mental disorder is necessarily manifested by external signs. Attacks of schizophrenia can be different in character, course. They indicate the form and severity of the disease. Having studied their manifestation, the specialist prescribes the appropriate treatment.

Mental disorders in people have always caused fear and confusion among healthy people. Healers have long tried to figure out where people with strange behavior come from. And only two centuries ago it was possible to describe the attacks of schizophrenia, the symptoms, and in the 20th century, doctors identified the types, forms and stages of the disease, its causes.

The course of schizophrenia involves the development of seizures from time to time.

According to the findings of a number of scientists who have been working to identify the causes of the disease for many years, there are a number of factors that provoke mental disorders.

Heredity- transmission of the disease at the genetic level from parents, grandparents, etc.
Psychoanalytic. The disease occurs due to stress, infectious diseases, injury, overvoltage.
Dopamine- an excess of this hormone affects the work of nerve impulses.
Dysontogenetic- the disease is already embedded in the human genes, and as a result external factors- trauma, stress, infection, etc., "floats" out.

How the disease manifests itself

Seizures of schizophrenia have a different character, it all depends on the type and form of the disease. But there is general symptoms inherent in almost all forms of mental illness.

Speech is disturbed, there is delirium, a sharp switch to another, strange topic, tongue-tied.
Complete lack of initiative, lack of will, independent actions.
Inadequate reaction to actions and statements, lack of emotions.
Megalomania, persecution, the constant manifestation of one's own exclusivity.

Seizures in mental disorders

With an exacerbation of mental illness, first of all, anxiety is observed for no reason.
The sufferer is subjected to an "attack" of non-existent voices, communicates with ephemeral personalities, beings.
There is insomnia, the patient often wakes up, walks from corner to corner.
There is a loss of appetite or vice versa, voracity. In this state, a schizophrenic can eat a portion many times the daily allowance.
There are outbreaks of aggression, anger, or the sick person hides in a corner, refuses to communicate with loved ones, completely withdraws into himself.
There is a desire to run away from home.
The patient becomes distrustful, may stop recognizing a loved one.

A person during an attack begins to worry for no reason

Important: the listed attacks in medicine are called psychosis. They require urgent relief, for which it is necessary to seek help - call a psychiatric team.

Alcoholic psychosis

Very often, with prolonged alcohol abuse, drug use, psychoses occur, which are confused with the first attack of schizophrenia (manifesto). The symptoms caused by a powerful intoxication of the body are really similar to a mental illness, but there are still distinctive features:

Delirium tremens. Due to the abolition of alcohol, drugs, the patient sees phantom creatures: devils, goblin, spiders, flies, etc., trying to catch them. frequent view hallucinations is the head of a dog, with which the sufferer may speak or be afraid of her. The characteristic signs of the behavior of a mentally ill person who had an attack of schizophrenia are reflected in the video, of which there are a huge number on the network.
hallucinations. Voices are heard that can threaten, order, criticize. Patients in such cases are sure that others also hear non-existent sounds.
Rave. Occurs against the background of prolonged alcohol intoxication, characterized by persecution mania, fear of being poisoned.
With prolonged alcohol consumption, brain cells are affected, there is encephalopathy. An alcoholic develops symptoms of schizophrenia: delusions, hallucinations, attacks of aggression, anger, he becomes uncontrollable. In severe cases, hospitalization in a specific institution is required.

The most dangerous is the acute phase of schizophrenia

How long does a schizophrenia attack last?

It is impossible to determine with accuracy how long a schizophrenic seizure lasts. It all depends on the individual indicators of a person, the form of the disease, aggravating circumstances. According to general data, there are several phases and each of them takes a certain period of time.

Acute (first) phase. The exacerbation lasts up to two months. The patient's thinking, memory worsens, loss of interest in work, study, and favorite activities is possible. The condition is aggravated by apathy, untidiness, lack of initiative. The patient often has excessive sweating, headache, dizziness, palpitations, anxiety, fears. With timely therapy, the prognosis is favorable, up to a long-term remission.
After effective cupping seizures, occurs stabilization stage. The process takes more than six months. The patient has symptoms in mild form, in rare cases, delusions, hallucinations are manifested. Without medical intervention, the acute phase continues to acquire threatening signs: memory loss occurs, delusional thoughts intensify, the patient hallucinates continuously. As a result, a complete loss of appetite, attacks of aggression with screams, howls are possible. Suicidal tendencies are obsessive.

An attack of schizophrenia: what to do

The main thing is not to bring a person's condition to acute phases. It is important to pay attention to the first signs of the disease and seek qualified help. If the process is started, you should calm the patient and at the same time call an ambulance for psychiatric help. It is impossible to cope with a mental illness without the intervention of a specialist.

During the acute phase, the patient may be dangerous to others

It is necessary to influence the brain cells, the patient's behavior with neuroleptic, nootropic drugs. The acute phase can carry a risk to life, both the patient and others. Often in a state of seizure, persons suffering from schizophrenia attacked people, maimed, committed violence. For those who first encountered the diagnosis of "schizophrenia", the video of the attack will tell you in detail what a sick person looks like, what character traits faces and behaviors are revealed. Thanks to this, it is possible to determine the disease without a doubt and turn to the right medical structure.

Schizophrenia is a chronic mental disorder that causes a range of different mental symptoms, such as hallucinations and behavioral changes. Doctors often refer to schizophrenia as a psychotic illness. This means that sometimes a person is not able to distinguish his own thoughts and ideas from reality.

The exact cause of schizophrenia is unknown. However, most experts agree that this disorder is due to the combined influence of genetics and environmental factors. It is believed that certain internal conditions make you more prone to schizophrenia, and certain situations can trigger the development of the disease.

Misconceptions about schizophrenia

There is an opinion that people with schizophrenia suffer from a split personality, that they can behave quite normally in this moment, and the next moment they suddenly start behaving illogically or eccentrically - they are not.

There is indeed a connection between violence and schizophrenia, but the media often exaggerate it by giving a lot of publicity to acts of violence committed by people with schizophrenia. Thus, they create a false impression that such actions are often performed.

Schizophrenia is one of the most common serious mental disorders. Approximately one in 100 people will develop schizophrenia during their lifetime, but many sufferers will continue to lead a normal life.

Schizophrenia is most often diagnosed between the ages of 15 and 35. Men and women get sick equally often. There is no single examination technique that helps diagnose schizophrenia. Most often, the diagnosis is made after evaluation by a mental health professional, such as a psychiatrist.

It is very important to diagnose schizophrenia at an early stage, as the chances of recovery are higher the sooner treatment is started.

Typically, schizophrenia is treated with antipsychotic medications and cognitive behavioral therapy. Many people recover from schizophrenia, but sometimes the symptoms may return (relapse occurs). Medication support helps to reduce the impact of the disease on the life of a sick person.

If you keep the course of the disease under control, you can reduce the risk of serious relapses. There are charities and support groups that offer help and advice on how to live with schizophrenia. Most people find comfort in talking to people living with the same disorder.

Symptoms of schizophrenia

Changes in thinking and behavior are the most obvious signs of schizophrenia, but symptoms can vary from person to person. The symptoms of schizophrenia are usually divided into two categories: positive (productive) and negative.

Positive symptoms are changes in behavior or thinking, such as hallucinations or delusions.
Negative symptoms are withdrawal or lack of responses or actions that you would expect to see in a healthy person. For example, people with schizophrenia often appear emotionless, lethargic, and apathetic.

The disease may develop slowly. The first signs of schizophrenia, such as social withdrawal and withdrawal or changes in sleep patterns, are not easy to identify because the first symptoms often appear during adolescence, and these changes can be mistaken for features of adolescence.

Often people experience bouts of schizophrenia when their symptoms are most pronounced, and then there is a period when there is little or no positive symptoms. This is called acute schizophrenia.

If you have symptoms of schizophrenia, see your doctor as soon as possible. The sooner treatment for schizophrenia is started, the more successful the outcome is usually.

hallucinations

A hallucination is when a person experiences a perception of something that is not really there. Hallucinations can affect any of the senses, but most often people hear voices.

Hallucinations are perceived by the person experiencing them as completely real, even if the people around him cannot hear or see what he hears or sees. Research using brain-scanning equipment shows changes in the speech brain of a person with schizophrenia when they hear voices. These studies have shown that the process of hearing voices is very real, as if the brain mistakes thoughts for real voices.

Some describe the voices they hear as friendly and pleasant, but more often they are rude, critical, rude, or annoying. Voices can describe the person's current actions, discuss their thoughts or behavior, give directions, or speak directly to the person. Votes may come from various places or from one specific, for example, from a TV.

crazy ideas

A crazy idea is an idea that a person strongly believes in, although it is based on an erroneous, strange, or unrealistic idea. It can affect a person's behavior. Delusions may start suddenly or develop gradually over weeks or months.

Some people develop delusions to explain the hallucinations they experience. For example, if they hear voices describing their actions, they may have the delusional idea that someone is watching their actions. A person experiencing paranoid delusions may be convinced that they are being persecuted and persecuted. He may believe he is being chased, followed, watched, plotted against, or poisoned, often blaming a family member or friend.

Some people who have delusional ideas find special meaning in ordinary events or occurrences. They may believe that people on television or in newspaper articles are conveying messages to them personally, or that the colors of cars passing down the street have a hidden meaning.

Confused thoughts (thought disorder)

In a state of psychosis, people often cannot maintain control over their thoughts and conversation. Some people find it difficult to concentrate and jump from one idea to another. They may find it difficult to read newspaper articles or watch television programs. Sometimes they describe their thoughts as "confused" or "unclear". Thoughts and speech may become chaotic or confused, making it difficult for others to understand.

Changing behavior and thoughts

Behavior may become more disorganized and unpredictable, and appearance or dressing may seem strange to others. People with schizophrenia may behave inappropriately or become very agitated and scream or swear for no reason.

Some say that their thoughts are controlled by someone else, that they are not their thoughts, or that the thoughts have been implanted into their minds by someone else. Another characteristic sensation is the disappearance of thoughts, as if someone is removing them from consciousness. Some feel that someone takes possession of their body and controls their movements and actions.

Psychosis

Coping with the first acute episode of psychosis can be difficult for both the sufferer and their family and friends. There may be drastic changes in behavior, the person may become upset, worried, confused, angry or suspicious of others. He may feel that he does not need help, and it can be difficult to convince him to see a doctor.

The negative symptoms of schizophrenia can often appear years before a person experiences the first acute attack. These initial negative symptoms are often referred to as the prodrome of schizophrenia.

During the prodrome, symptoms tend to come on gradually and worsen slowly. These include increasing social exclusion and increasing indifference to one's appearance and personal hygiene.

Determining whether these symptoms are part of the development of schizophrenia, or caused by something else, can be difficult. Negative symptoms seen in people with schizophrenia include:

loss of interest and motivation in life and activities, including personal relationships and sex;
loss of concentration, reluctance to leave the house and changes in sleep patterns;
reluctance to start a conversation and feeling uncomfortable in the company of people, feeling that you have nothing to say.

The negative symptoms of schizophrenia often lead to problems in relationships with friends and loved ones, as they can be mistaken for deliberate laziness or rudeness.

Causes of schizophrenia

The exact causes of schizophrenia are not known, but research suggests that a combination of physical, genetic, psychological and environmental factors may cause greater susceptibility to the disease.

To date, it is believed that some people may have a predisposition to schizophrenia, and any event that entailed stress or intense experience can trigger an attack of psychosis. However, it is still unknown why some people develop symptoms and others do not.

Risk factors for schizophrenia

Hereditary predisposition to schizophrenia. There is a tendency for schizophrenia to run in families, but no single gene is responsible for this. Most likely, different combinations of genes can make a person more susceptible to this disease. However, having these genes does not mean that you will definitely develop schizophrenia.

Evidence that this condition is partly hereditary comes from studies of identical twins reared separately. They were compared with fraternal twins reared separately and with the general population. Among identical twins, if one of them develops schizophrenia, there is a 50% chance that the other will also develop this disease. Among fraternal twins, who share only half of their genetic characteristics, if one twin develops schizophrenia, the chance that the other twin will develop the disease is 1 in 7.

And although this is higher than in the general population (where the probability is 1 in 100), this leads to the idea that genes are not the only factor influencing the development of schizophrenia.

Brain development. Many studies of people with schizophrenia have shown that there are subtle differences in the structure of their brains or small changes in the distribution or number of brain cells. These changes are not observed in all patients with schizophrenia and occur in people who do not have mental disorders. This suggests that some of the schizophrenia may be due to a brain disorder.

Neurotransmitters (neurotransmitters) - this is chemical substances that transmit signals between brain cells. There is a link between neurotransmitters and schizophrenia, as drugs that change the levels of neurotransmitters in the brain are known to improve some of the symptoms of schizophrenia.

Research findings suggest that schizophrenia may be caused by alterations in two neurotransmitters: dopamine and serotonin. Some studies indicate that an imbalance of these two substances may be at the root of the problem. Others argue that part of the cause of schizophrenia is the body's susceptibility to neurotransmitters.

Complications during pregnancy and childbirth have little to no effect on schizophrenia, but studies have shown that the following factors can make a person more likely to develop schizophrenia in the future:

bleeding during pregnancy, gestational diabetes, or preeclampsia;
abnormal growth of the baby in the womb, including low birth weight or small head circumference;
virus infection in the womb;
complications during childbirth, such as lack of oxygen (asphyxia) and an emergency caesarean section.

Triggers (triggers) of schizophrenia

Triggers are factors that can trigger the development of schizophrenia in people at risk.

The main psychological triggers for schizophrenia are stressful events such as the death of a loved one, loss of a job or home, divorce or relationship breakdown, and physical, sexual, emotional, or racial abuse. These events, while stressful, are not the causes of schizophrenia, but they can trigger it in those who are already susceptible to the condition.

Drugs are not a direct cause of schizophrenia, but studies have shown that drug abuse increases the risk of developing this or similar illnesses.

Certain drugs, such as marijuana, cocaine, LSD, or amphetamines, can trigger some of the symptoms of schizophrenia, especially in people who are susceptible to the condition. Amphetamine or cocaine use can lead to psychosis and cause a relapse in people recovering from an earlier attack.

Three large studies have shown that adolescents under 15 years of age who regularly use marijuana, especially "skunk" and other more powerful types of this drug, have a 4-fold increase in the risk of developing schizophrenia by the age of 26.

Diagnosis of schizophrenia

There is no single test to diagnose schizophrenia. Most often, the diagnosis is made after an assessment by a mental health professional. If you find that you may be developing symptoms of schizophrenia, see your doctor as soon as possible. The sooner treatment for schizophrenia is started, the more successful the outcome is usually.

Your doctor will ask you about your symptoms and check if they have other causes, such as occasional drug use.

To make a diagnosis, most specialists use a "diagnostic checklist" in which the presence of certain symptoms and signs indicates that a person has schizophrenia.

Typically, the diagnosis of schizophrenia is made in the following cases:

You have at least 2 of the following symptoms: delusions, hallucinations, thought or behavior problems, or negative symptoms such as dullness of emotions.
Your symptoms have a strong impact on your ability to work, study, or perform daily tasks.
You have been experiencing these symptoms for more than 6 months.
All other possible causes, such as occasional drug use or depression, were excluded.

Similar diseases

It is not always clear whether a person has schizophrenia. If at the same time you have other symptoms, the psychiatrist has reason to conclude that you have a similar mental disorder.

There are several mental disorders similar to schizophrenia. Your psychiatrist will ask you what effect your illness has on you in order to confirm with certainty that you have schizophrenia and not another mental disorder, for example:

Bipolar disorder (manic-depressive psychosis). People with bipolar disorder experience sudden transitions from mania (high spirits and increased activity, agitation) to periods of deep depression. Some people with bipolar disorder also hear voices or experience other types of hallucinations or may have delusions.
Schizoaffective disorder It is often described as a form of schizophrenia because its symptoms are similar to those of schizophrenia and bipolar disorder. However, schizoaffective disorder is a separate mental illness. It may occur only once in a person's life, or it may occur periodically, often under the influence of stress.

How to help someone with schizophrenia

Because of their delusional complexes, people with schizophrenia may avoid seeing a doctor if they think they are fine.

Most likely, a person who has suffered bouts of acute schizophrenia in the past will be under the supervision of a psychiatrist. In this case, you should contact this doctor and tell him about your suspicions.

If a person is experiencing an attack of acute schizophrenia for the first time, a friend, relative, or loved one may have to convince them to see their doctor. In the event of a rapidly worsening schizophrenia attack, you may need to seek emergency psychiatric help.

If a person experiencing an attack of acute schizophrenia refuses to seek help and there is reason to believe that they pose a threat to themselves or others, their next of kin may request a psychiatric evaluation.

After diagnosis

If you (or a friend or relative) has been diagnosed with schizophrenia, you may feel anxious about what will happen next. You may be preoccupied with the stigma attached to this disease, or scared and withdrawn. It is important to remember that a diagnosis can be a positive step towards getting correct, accurate information about the disease and available treatments and services.

Treatment of schizophrenia

Typically, schizophrenia is treated with a personalized combination of psychotherapy and medication.

In developed countries, an approach to the treatment and care of patients with schizophrenia has been developed, according to which the doctor should:

develop supportive relationships with patients and caregivers;
explain causes and treatment options, minimize the use of medical terms, and provide written information for each step of the treatment process;
provide easy access to evaluation and treatment;
work with patients, and their families, if they agree, to write an advance directive for mental and physical treatment;
take into account the needs of the patient's family or caregivers;
encourage patients and their families to join a mutual help group.

Voluntary and involuntary hospitalization for schizophrenia

More severe, acute episodes of schizophrenia may require hospitalization in the psychiatric ward of a hospital or clinic. You can voluntarily go to the hospital if your psychiatrist thinks it's necessary.

Under the Psychiatric Care Act (1992), people can also be subjected to involuntary hospitalization.

According to Article 29 of the Law "On Psychiatric Care and Guarantees of the Rights of Citizens in its Provision", a person suffering from a mental disorder may be hospitalized in a medical organization providing psychiatric care in stationary conditions, without his consent or without the consent of one of the parents or other legal representative before the decision of the judge, if his psychiatric examination or treatment is possible only in inpatient conditions, and the mental disorder is severe and causes:

his immediate danger to himself or others, or
his helplessness, that is, his inability to satisfy the basic needs of life on his own, or
significant harm to his health due to the deterioration of his mental state, if the person is left without psychiatric care. When a person with schizophrenia is involuntarily hospitalized, it may be necessary to keep him in a locked room.

Antipsychotics (neuroleptics) for the treatment of schizophrenia

As a rule, antipsychotics are prescribed as initial therapy in the treatment of an attack of acute schizophrenia. The action of antipsychotics is to suppress dopamine activity in the brain.

Typically, antipsychotics reduce anxiety or aggression within hours of taking them, but other symptoms, such as hallucinations or delusions, may take several weeks to improve.

Antipsychotics can be taken by mouth (as a tablet) or as an injection. There are several "long-acting" antipsychotics. These drugs should be administered 1 time every 2-4 weeks.

You may need to take antipsychotics only until the acute schizophrenia is over. However, most people continue to take the drug for 1 to 2 years after an attack has ended to prevent future attacks, or longer if attacks recur regularly.

There are 2 main types of antipsychotics:

Typical antipsychotics are the first generation of antipsychotics developed in the 1950s.
Atypical antipsychotics are a new generation of antipsychotics developed in the 1990s.

Atypical antipsychotics are preferred in treatment choice due to the composition of side effects associated with their use. However, they are suitable and not suitable for everyone.

Both typical and atypical antipsychotics have side effects, although not everyone will experience them and their severity will vary from patient to patient.

Side effects of typical antipsychotics include:

muscle cramps;
muscle spasms.

Side effects of both typical and atypical antipsychotics include:

drowsiness;
weight gain, especially with certain atypical antipsychotics
darkening in the eyes;
constipation;
lack of sexual desire;

If side effects get worse, tell your doctor. You may be prescribed a different antipsychotic or additional drugs to help manage side effects.

Do not stop taking antipsychotics without talking to your doctor. If you stop taking the drug, you may experience a relapse of your symptoms.

Psychological therapy

Psychotherapy can help people with schizophrenia cope better with symptoms such as hallucinations and delusions.

It also helps with some of the negative symptoms of schizophrenia, such as apathy or an inability to experience pleasure.

Cognitive Behavioral Therapy (CBT) is designed to help you recognize the thoughts that are causing you unwanted emotions and behaviors and teach you how to replace those thoughts with more realistic and helpful thoughts.

For example, you can be taught to identify your own crazy ideas. You can then be helped and advised on how to avoid doing anything based on these delusions.

Most people require 8-20 CBT sessions over a 6-12 month period. 1 CBT session usually lasts about an hour.

Your doctor may refer you to a CBT specialist.

Family therapy. Many people with schizophrenia rely on the care and support of family members. While most families are happy to help, caring for a person with schizophrenia can be overwhelming for any family.

Family therapy is designed to help you and your family cope better with your illness.

Family therapy involves a series of informal meetings over the course of about six months. During the meetings it is possible:

discussing information about schizophrenia;
considering ways to help a person with schizophrenia;
finding solutions to practical problems that may be caused by the symptoms of schizophrenia.

If you think therapy can help you and your family, talk to your doctor about it.

Art therapy designed to develop creative expression. Working with an art therapist in small groups or individually will give you the opportunity to express your experience of living with schizophrenia. Some people find that non-verbal self-expression through art provides a new experience of understanding schizophrenia and helps them develop new ways of interacting with others.

For some people, art therapy has helped alleviate the negative symptoms of schizophrenia.

Lifestyle of a schizophrenic patient

Most people with schizophrenia recover, although many will experience a return of symptoms (relapse) from time to time.

Through therapy and support, you will be able to control your illness so that it doesn't have a big impact on your life.

Learn to recognize the signs of an acute attack of schizophrenia

Learning to recognize the signs that you are getting worse will help you control your illness. These signs include loss of appetite, feelings of anxiety, stress, or sleep disturbances. You may also notice the development of less dramatic symptoms, such as becoming suspicious or fearful, worrying about people's motives, hearing voices that are quiet or intermittent, and finding it difficult to concentrate. You can also ask someone you trust to tell you if they notice a change in your behavior.

Recognizing the first signs of an acute attack of schizophrenia can be helpful, as an attack can be avoided with antipsychotics and additional support.

If you have a new acute episode of schizophrenia, you must follow your written care plan. Your care plan will include likely signs of a developing relapse and steps to take, including emergency phone numbers.

Refrain from alcohol and drugs

While alcohol and drugs may give you a short-term reprieve from schizophrenia symptoms, they will likely only exacerbate these symptoms in the long run. Alcohol can cause depression and psychosis, and drugs can make your schizophrenia worse.

Also, alcohol and drugs, when combined with antipsychotic drugs, can cause a negative reaction of the body.

If you are currently using drugs or alcohol and cannot stop, seek help from your doctor.

Take your medicine

It is important to take your medicines as directed by your doctor, even when you are feeling better. Consistent medication can help prevent relapses. Talk to your doctor if you have any questions or concerns about medications you are taking or side effects.

You should also read the package leaflet of your medication for how this medication works with other medications or dietary supplements. If you are going to use any over-the-counter medications, such as pain relievers or nutritional supplements You should also check with your doctor as these may interfere with your medications.

Get checked regularly

As part of your treatment program, you will communicate regularly with your healthcare providers. A good relationship with these professionals gives you the freedom to discuss your symptoms and concerns with them. The more they know, the better they can help you.

Take care of yourself

Self care is an integral part of your Everyday life. This means that you are responsible for your health and wellness with the support of the people involved in your care.

Self-care includes what you do every day to stay fit, maintain good physical and mental health, prevent illness and accidents, and effectively manage illness and chronic disease.

For people with a chronic illness, having support in self-care will be a big advantage. They will be able to live longer, experience less pain, anxiety, depression and fatigue, have a higher quality of life and be more active and self-reliant.

Healthy lifestyle

In addition to monitoring your mental health, your health care provider should also monitor your physical health. A healthy lifestyle, including a balanced diet rich in fruits and vegetables, and regular exercise are good for you and may reduce your risk of developing cardiovascular disease or diabetes.

Get a health check-up at least once a year to monitor your risk of developing heart disease or diabetes. The examination includes weighing, measuring blood pressure and taking necessary blood tests.

There are 3 times more smokers among people with schizophrenia than among the general population. If you smoke, you have an increased risk of cancer, heart disease, and stroke.

Quitting smoking will have a positive impact on your health in both the short and long term. Studies have shown that you are 4 times more likely to quit smoking if you have the support of a nicotine addiction specialist and anti-smoking drugs such as patches, gum or inhalers.

Typical questions for which a person with schizophrenia may seek help from medical and social support agencies, in addition to treatment: social adaptation, Employment, Benefits, Accommodation A person with a potential schizophrenia has the opportunity to receive help from the following professionals:

psychiatrist;
psychotherapist;
psychologist;
Social worker.

How can family, friends and loved ones help me?

Friends, relatives and loved ones play a vital role in helping people with schizophrenia get better and reduce their risk of relapse.

It is very important not to blame the person with schizophrenia and not to tell them to "pull themselves together" or to blame other people. If your friend or loved one has a mental disorder, it's important to stay positive and supportive.

In addition to providing support to a person with schizophrenia, you may need help yourself in order to cope with your own experiences. A number of voluntary organizations provide assistance and support to people caring for their loved ones with schizophrenia.

Friends and relatives should try to understand what schizophrenia is, how it affects the person, and how they can best help. They can provide emotional and practical support and can persuade a person to seek appropriate help and treatment. As part of your treatment, you may be offered family therapy. There you can get information and support for a person with schizophrenia and their family.

Friends and family can play an important role by monitoring a person's mental state, looking for any signs of a relapse, and making sure the person is taking their medication and attending their doctor's appointments.

If you are the next of kin of a person with schizophrenia, you have certain rights that can be used to protect the interests of the person with schizophrenia. These include asking the psychiatric service to send a qualified psychiatrist who can determine whether a person with schizophrenia requires hospitalization.

depression and suicide

Many people with schizophrenia go through periods of depression. Don't ignore these symptoms. If depression is left untreated, it can worsen and cause suicidal thoughts.

Studies have shown that people with schizophrenia are more likely to commit suicide.

If during the past month you have been feeling particularly depressed and no longer enjoy the things you used to enjoy, you may be depressed. See your doctor for advice and treatment.

If you have suicidal thoughts, tell your doctor right away.

Signs that a person suffering from depression and schizophrenia may be contemplating suicide include:

making final preparations, such as distributing property, making a will, or saying goodbye to friends;
talk about death and suicide. It can be a direct statement, for example: “It’s a pity that I’m not dead,” or indirect statements, for example: “I think dead people should be happier than us” or “But it would be nice to fall asleep and not wake up!”;
a person harms himself, such as cutting his arms or legs, or burning his skin with a cigarette;
a sudden improvement in mood, which may mean that the person has decided to kill himself and feels better about the decision.

If you notice any of these signs:

seek professional help for this person, such as a therapist or psychiatrist;
let him know that he is not alone and that you care about him;
Offer to help find other solutions to this person's problems.

If you feel that there is an immediate threat that the person will kill himself, stay with him or ask someone else to stay with him and get rid of all available funds suicide, such as sharp objects and potentially dangerous drugs.

Which doctor should I contact for schizophrenia?

With the help of the NaPopravku service, you can find a good psychotherapist or psychiatrist, and also find out how these specialties differ by using the section "Who treats it".

In addition, you can choose a good psychiatric clinic for hospitalization and full treatment schizophrenia.

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This form of the disease is characterized by the development of seizures of various psychopathological structures and the presence of remissions of a sufficiently high quality.

Acute paraphrenic states can develop during various attacks of recurrent schizophrenia, both affective and oneiroid-catatonic.

The duration of attacks of recurrent schizophrenia is usually several months. Along with this, the development of short-term, transient conditions lasting from several days to 1-2 weeks is possible. [Kontsevoi V. A., 1965; Savchenko L. M., 1974]. Quite frequent and protracted, lasting for many months, and sometimes for many years, seizures, primarily depressive ones, which are distinguished by therapeutic resistance [Pchelina AL, 1979; Titanov A. S., Pchelina A. L., 1981].

If the disease proceeds with the same type of attacks, then along with cases when all attacks during the life of the patient have a oneiroid-catatonic structure, one has to observe those in which the proportion of the oneiroid itself in each subsequent attack decreases. Often, within the framework of the considered variant of the course of the disease, from attack to attack, the unity of the plot of the patient's experiences is preserved (alternating consciousness, according to H. Gruhle). H. Weitbrecht (1979) noted this feature in case of periodic catatonia.

In recurrent schizophrenia, both double and triple seizures can develop. In addition, there is a course of the type continua, with a continuous change of manic and depressive states.

Paroxysmal progressive schizophrenia

Paroxysmal progressive schizophrenia is a combination of a continuous and paroxysmal course or a paroxysmal course of a disease with a variety of acutely and subacutely developing psychotic conditions, varying degrees of progression and the corresponding different severity of a mental defect and personality changes.

Initially, cases now referred to as paroxysmal progressive schizophrenia were considered as an expression of a combination of a sluggish continuous course and attacks of recurrent schizophrenia. However further research showed that the range of disorders, reflecting both the continuous nature of the disease process and seizures, goes beyond such ideas. It was found that, although in some cases the disease is exclusively paroxysmal in nature, the degree of progression of the disease process in this form of the course is quite pronounced and varies widely, leading in some patients to a rapid increase in the defect from attack to attack, and in others to a relatively subtle personality changes.

This form of schizophrenia is often also called fur-like (from German schub - shift). It means that after each attack there comes a personal shift, a "break" of the personality. However, not every attack in this sense can be qualified as a fur coat, because after some attacks, gross distortions of the personality do not develop.

Depending on the characteristics of the clinical picture and the degree of progression of the disease, paroxysmal-progressive schizophrenia is divided into several options. One of them is similar to juvenile schizophrenia with a malignant course, the other is similar to paranoid schizophrenia, the third is sluggish; in addition, schizoaffective paroxysmal-progredient schizophrenia is distinguished. The above division confirms the intermediate position of paroxysmal-progressive schizophrenia between continuous and recurrent.

Malignant paroxysmal progressive schizophrenia It is close in its clinical manifestations to juvenile malignant continuous schizophrenia and consists of signs of a continuous course and seizures developing against it.

As in juvenile malignant schizophrenia, the disease begins gradually - with a drop in energy potential, manifested by a decrease in academic performance, inactivity and loss of former interests, as well as increasing emotional deficits and the development of rudimentary depersonalization, dysmorphic, catatonic disorders.

Already in the initial period of the disease, affective disorders appear, characterized by atypia and “dullness” of affect. It is usually about hypomanic and subdepressive states. During this period, psychopathic disorders are detected.

As the disease develops, hypomanic states increasingly lose their inherent features of hypomania: gaiety is replaced by euphoria with foolishness, there is no desire for activity, disinhibition of drives appears, an unmotivated feeling of hostility towards loved ones, and separate ideas of attitude. In subdepressions, lethargy, a feeling of disgust for any kind of activity, irritability, rudeness, a tendency to abuse alcohol, and impulsive suicidal attempts are noteworthy. Both in the state of hypomania and subdepression, patients occasionally experience rudimentary catatonic disorders in the form of stereotypy, grimacing, and freezing in monotonous poses. Quite often, affective disorders acquire the character of a continuum with a continuous change of hypomanic and subdepressive states.

The manifestation of the disease usually occurs at the age of 12-14 years, 2-2.5 years after the beginning of the described initial period, i.e. against its background.

Manifest psychoses often resemble psychoses that develop with continuous juvenile schizophrenia. In this case, they are characterized by extreme polymorphism and non-development of symptoms: atypical affective disorders are combined with fragmentary delusional ideas of relationship, persecution, hallucinatory and pseudo-hallucinatory disorders, signs of mental automatism, catatonic manifestations in the form of substuporous episodes, alternating with excitement with impulsiveness or foolishness. It is also possible to develop catatonic psychoses with lethargy, turning into a persistent substupor with rudimentary ideas of attitude, separate hallucinations, pseudo hallucinations.

After the manifest, i.e., the first attack of the disease, pronounced signs of schizophrenic personality changes are found. Remissions are characterized by short duration, instability and the presence of rudimentary symptoms of the delusional and catatonic registers. After 2-3 attacks of the disease, social maladjustment and a gross schizophrenic defect are revealed. Unlike juvenile malignant continuous schizophrenia, patients with this form of the disease can be adapted to simple types of work. They have a consciousness of their own change. Selective attachment to relatives is also characteristic.

Sometimes it is necessary to observe quite persistent and prolonged remissions with varying degrees of personality changes.

Attack-like progressive schizophrenia close to paranoid, differs in rather expressed polymorphism of attacks. Clinical manifestations of the disease are different. In some cases, we are talking about the development against the background of a continuous course with paranoid disorders or interpretive delusions of seizures with a predominance of delusional and hallucinatory disorders in their picture, in others, the disease manifests itself exclusively in the form of seizures (while acute conditions with paranoid or interpretive delusions are also possible) .

The onset of the disease, i.e., the onset of the first attack of the disease, may be preceded by personality shifts that usually develop after erased attacks of the disease, or slowly increasing personality changes in the form of smoothing out the patient's inherent character traits or, conversely, the appearance of unusual character traits. There is a drop in mental activity, narrowing of the circle of interests, leveling of emotional reactions.

Perhaps the development of mild affective disorders: hypomania and subdepression with a predominance of psychopathic manifestations in the picture, behind which it is not always possible to recognize affective disorders.

A manifest attack of the disease is preceded directly by the development of paranoid disorders or interpretive delusions with varying degrees of systematization and, as a rule, with mild personality changes.

Attacks in the picture of the described variant of paroxysmal-progredient schizophrenia are characterized by acutely developing interpretive (paranoid) delusions, hallucinosis, Kandinsky-Clerambault syndrome, paraphrenia.

Acute seizures with interpretive delusions characterized by a gradual or rather acute development of more or less systematized delirium that occurs against the background of unreasonable internal tension, vague anxiety, restlessness, delusional mood. The emerging mono- or polythematic delirium subsequently tends to expand and develop episodes of sensory delirium in the form of staging phenomena. The emergence of sensual delirium is usually preceded by the appearance of anxiety, fear; resolution of an acute condition is accompanied by the development of a reduced mood background with incomplete criticism of not only the period of sensory delirium, but also interpretive delirium.

Attacks of acute hallucinosis develop against a background of low mood with anxiety, alertness, separate ideas of attitude and persecution. At first, hails arise: the patient hears swear words spoken to him. Further, hallucinosis develops with commentary and imperative content, sometimes transforming into pseudohallucinosis. Hallucinosis can develop at the height of the attack and with the phenomena of acute paranoid: the condition is characterized by significant kaleidoscopicity, variability, either sensual delirium or hallucinatory disorders come to the fore in the picture of the syndrome.

Seizures with acutely developing Kandinsky-Clerambault syndrome usually develop against the background of affective disorders of a manic or depressive nature. The phenomena of mental automatism predominate - individual ideational disorders up to a total mastery syndrome or pseudo-hallucinatory disorders with the possibility of further development of pseudo-hallucinatory delirium. Often the phenomena of mental automatism are closely intertwined with interpretive delirium. Sometimes the development of mental automatisms in the picture of interpretive delirium is accompanied by a change in the plot of the latter.

An attack with a picture of acute paraphrenia characterized by the presence of antagonistic (fantastic) delusions with ideas of grandeur and a picture of pseudo-hallucinatory paraphrenia.

The occurrence of attacks of various psychopathological structures, their modification occurs in accordance with the general patterns of changing syndromes characteristic of paranoid schizophrenia, i.e., after an attack with interpretive delusions, an attack with hallucinosis or the Kandinsky-Clerambault syndrome develops and then an attack with a picture of acute paraphrenia.

The quality of remissions after these attacks is different. It is determined by the severity of personality changes and the presence of residual psychotic disorders. The nature of personality changes varies from mild to significant with a drop in mental activity and social maladaptation. During periods of remission, there are often rudimentary psychopathological disorders of the delusional and hallucinatory register, and often there is no complete criticism of the psychosis. Unfortunately, there is no definite data on the prognostic significance of seizures of various psychopathological structures.

Attack-like progredient schizophrenia, close to sluggish, is a variant of the disease in which disorders reflecting the continuous nature of the process are characterized by obsessions, depersonalization phenomena, hypochondriacal, senestopathic and hysterical disorders. A manifest attack may be preceded by cyclothymic fluctuations, often of a continual nature, which are, as it were, a prototype of subsequently developed affective seizures. Seizures that occur against this background, as a rule, are affective - more often depression and less often mania. With a significant severity of affective disorders during an attack, disorders that reflect the continuous nature of the process do not occupy the main place in the patient's condition, and in cases of attacks with mildly pronounced affective disorders, the intensity of such disorders is more pronounced: there is a "coverage" of patients with obsessions, senestohypochondria and other experiences . Sometimes dual affective attacks develop (depression-mania, mania-depression). Along with cases when seizures acquire the character of a cliché, with this variant of the course of schizophrenia, their structure may become more complicated with the development of sensory delusions.

After one or more attacks, the picture of the disease stabilizes and consists of residual neurosis-like symptoms and personality changes, which gives reason to qualify this stage of the disease as residual schizophrenia.

The presented division of paroxysmal-progressive schizophrenia is not absolute. This applies primarily to the relationship between disorders that reflect the continuous nature of the process, and seizures that occur against their background.

It is known that against the background of deficient symptoms resembling the "simplex syndrome", not only seizures similar to psychoses observed in juvenile malignant schizophrenia can develop, but also affective and affective-delusional. The same can be observed in cases where the disorders are interpretive or paranoid delusions. Against the background of neurosis-like symptoms, seizures develop, the clinical picture of which is characterized by hallucinosis or acute paraphrenia. In other words, the described tropism of certain types of attacks to various variants of a continuous course is not mandatory.

An analysis of seizures that are different in their psychopathological picture shows that they also have significant common features. First of all, we are talking about the heterogeneity of the structure of seizures, which concerns, in particular, the dissociation between the acute picture of sensory delirium and the outwardly ordered behavior of the patient, as well as a kind of inconsistency of disorders with each other. This means that expansive paraphrenia with an elevated background of mood can be combined in a patient with hypochondriacal delirium or painful senestopathies. Noteworthy is the lack of a critical attitude to the experienced attack, despite the sufficient safety of the patient - the absence of pronounced personality changes, reduction of energy potential.

It should also be noted the prognostic significance of various types of seizures. Unfortunately, there are still no criteria that, with a significant degree of probability, would allow prognostic considerations to be made on the basis of the psychopathological structure of the attack, and nevertheless, the nature of the seizures observed in paroxysmal-progressive schizophrenia allows us to generalize the relevant clinical observations. The manifest attack of oneiroid catatonia suffered by the patient does not in all cases indicate a recurrent course of schizophrenia. Often, after such an attack, prognostically, at first glance, quite favorable, pronounced personality changes unusual for the recurrent course can develop, which gives the right to designate the corresponding attack as a fur coat, that is, a shift in the patient's mental state. At the same time, even with a paroxysmal-progressive course, the development of an attack of oneiroid catatonia may not affect the further course of the disease, which excludes the qualification of this condition as a fur coat.

In some cases, the disorders observed at the beginning of the disease, resembling the picture of the “simplex syndrome” or a sluggish course after one of the attacks, can be transformed into a state with interpretive or paranoid delusions. And, conversely, changes in the nature of disorders that characterize the continuous course of the disease are not always accompanied by a change in the nature of seizures.

Thus, the clinical manifestations of paroxysmal progressive schizophrenia are extremely diverse. Along with cases that undoubtedly approach the variants of continuous and recurrent schizophrenia, when there is a “tropism” of seizures of a certain psychopathological structure to various types of continuous flow, there are a large number of observations where this relationship is absent.

The question arises: what cases of paroxysmal-progredient schizophrenia are the most characteristic for her - close to continuous and recurrent schizophrenia or those in which there are no certain patterns in the development of the disease and it is impossible to catch the logical sequence in the occurrence of seizures. With certainty, we can say that we are talking about a continuum, where at one pole there are cases that obey certain patterns of development of the disease, and at the other - cases in which there is no such pattern; the space between them is occupied by clinical observations gravitating towards different poles.

Questions about the prognostic significance of seizures and the course of paroxysmal progredient schizophrenia as a whole most clearly arise in cases of the course of the disease with so-called febrile seizures, or febrile schizophrenia (see the section "Special forms of schizophrenia").