Sluggish schizophrenia. Sluggish schizophrenia - symptoms and signs in men Sluggish form of schizophrenia

Sluggish schizophrenia is one of the few types of mental illness that is usually not accompanied by the appearance of pronounced productive symptoms, that is, delusions and hallucinations. This type of course of schizophrenia is the most favorable, since when proper treatment complete remission can be achieved. The thing is that the sluggish type of schizophrenia is characterized by an extremely slow development of this mental illness, which leads to minimal mental disorders, abilities to thought processes and adequate perception of the surrounding world.

Some researchers believe that calling schizophrenia sluggish in a certain sense is incorrect and it would be more correct to consider such manifestations in humans as schizotypal disorder or low-progressive schizophrenia. Such a schizotypal disorder can be easily treated with medication, and if patients comply with preventive measures unpleasant symptoms will manifest themselves extremely weakly or not at all.

Symptoms

According to statistics, low-progressive schizophrenia occurs much more often in women than in men. Over a long period of time, the symptoms caused by such a schizotypal personality disorder can be so subtle and mild that most people around them perceive the existing manifestations as minor personality traits. At the same time, it should be borne in mind that low-grade schizophrenia, like any other type of this mental illness, has several stages of development, including:

• latent;
• active;
• stabilizing.

During the latent period, a person with sluggish schizophrenia may experience only minor manifestations, including refusal to communicate with other people, long-term depression, somatic reactions, social phobia, etc. If treatment low-grade schizophrenia has not been carried out in women, there may be attacks of exacerbation of the course, accompanied by severe hysterics, progressive hypochondria, in which a person begins to experience irrational fear that he has some kind of terrible disease.

Such neurosis-like schizophrenia during the period of exacerbation makes a person simply unbearable and touchy, which often becomes the reason that many relatives and friends abandon him. Often, against the background of progression of sluggish schizophrenia, patients may experience such pathological condition like depersonalization. This state is characterized by the feeling that all the actions that the patient performs are perceived by him detachedly, as if he were an outside observer of all the events in which he was directly involved.

People suffering from sluggish schizophrenia, as a rule, maintain sobriety of thought, can perfectly put together logical chains without obvious errors, but at the same time they have a number of irrational fears and phobias that determine their damage. Signs of low-grade schizophrenia in women can increase significantly during pregnancy and childbirth. Women suffering from this schizotypal disorder experience exhaustion and labor activity significantly more often provoke the development postpartum depression. The reasons for the exacerbation of sluggish schizophrenia after childbirth may be rooted in hormonal changes occurring during this period.

Treatment methods

Given that low-grade schizophrenia has very few symptoms, many people suffering from this mental illness do not receive adequate treatment. medication assistance due to lack of timely diagnosis.

Treatment for early stage development of sluggish schizophrenia guarantees a quick and very high-quality effect.

It is important to note that people suffering from such a schizotypal disorder do not need urgent hospitalization, routine examinations in a hospital, or treatment at home. If you have any concerns about the presence of sluggish schizophrenia, you should not think that treatment will take place within the walls of a psychiatric hospital and under the close supervision of doctors. Treatments for people suffering from low-grade schizophrenia include:

• drug support;
• psychocorrection;
• socialization;
• encouragement for work or creative activity.

Usually, in order to eliminate existing symptoms, drugs belonging to the group of antipsychotics are selected, and in maintenance dosages. A person suffering from indolent schizophrenia must undergo treatment with a psychotherapist, as this will allow him to quickly get rid of existing phobias and behavioral quirks, and then acquire skills to interact with other members of society. In addition, you need to pay Special attention that some people suffering from low-grade schizophrenia experience a burst of creative energy. It is very important to support such aspirations, since creativity allows you to release those emotions that a person tries to suppress. Expressing oneself in creativity allows a person suffering from low-grade schizophrenia to quickly regain confidence and learn to be part of social society again.

It was found that occupational therapy has a positive effect on the condition of people with such schizotypal disorder. Performance various tasks allows a person to feel important and more easily accept their illness. If treatment with such methods did not produce a significant result or the pathology was detected on late stages, may require short-term hospitalization in a psychiatric hospital and undergoing intensive course drug therapy.

Mental illnesses such as schizophrenia raise more questions among specialists than answers. Sluggish schizophrenia is one of many types of disorder, the etiology of which is still unclear. It is considered a disease of dissident people: philosophers, esotericists, people of a creative mind.

What is low-grade schizophrenia?

Sluggish or poorly progressive schizophrenia is a form of schizophrenia with mild or erased symptoms of manifestation. The disease is mild, without a clear clinical picture characteristic of other forms. IN international classification diseases (ICD) is listed as . In Soviet times, low-grade schizophrenia was “diagnosed” in persons subject to repressive measures.

How to distinguish neurosis from sluggish schizophrenia?

The diagnosis of schizophrenia is often questioned by psychiatrists. A carefully collected anamnesis and observation do not always confirm the presence of an illness. Depressive, neurotic and personality disorders in some manifestations are similar to the symptoms of low-progressive schizophrenia, so diagnosis is difficult. The difference between sluggish schizophrenia and neurosis is that the personality of neurotic disorders is preserved. There are other differences:

1. Neurosis is based on a specific psychotraumatic situation as a starting point that worsens over time (prolonged stress). Schizophrenia is genetically determined.
2. With neurosis, a person retains the state of what happens to him. In schizophrenia there is no criticality.
3. Over time, the symptoms of sluggish schizophrenia worsen, the personality defect increases: emotions become scarce, painful fantasies intensify, will disappears. Neurosis is a condition that can be corrected and reversible.

The first signs of the disorder are observed in adolescence. The onset of low-grade schizophrenia can be triggered by the use of psychoactive substances, alcohol, heavy stressful situation. Making a diagnosis is difficult, since the symptoms become clear only at the peak of the disease. At an early stage, all manifestations are similar to many mental disorders. Sluggish schizophrenia - symptoms:

• decreased activity;
• narrowing your circle of interests and friends;
• strangeness and eccentricity are noted in behavior;
• fears;
• obsessive thoughts, ideas;
• depersonalization (a person hears and sees himself as if from the outside);
• episodic hallucinations;
• emotional impoverishment, coldness.

Symptoms also depend on the predominant type of sluggish schizophrenia:

1. Psychopathic-like schizophrenia. Characterized by the loss of “I”: when looking in the mirror, they perceive themselves as an outsider. Pretentiousness and mannerism predominate in behavior, the person is prone to hysterics. Deceitfulness and tendency to vagrancy are increasing.
2. Neurosis-like sluggish schizophrenia. Characterized by the presence of various kinds of phobias, a person over time acquires various kinds of fears:

• agoraphobia;
• mysophobia;
• cancerophobia.

Signs of low-grade schizophrenia in men

The development of the disease, course and symptoms depend little on, rather on the character and individual characteristics, but according to average statistical data, sluggish schizophrenia in men begins at more early age, progresses faster, treatment will be more complex and lengthy. The peak of the disease occurs between 19 and 28 years of age. Signs of the disorder typical for men:

• rapid impoverishment of the emotional sphere;
• in conversation: incoherent speech with pretentious fragments of phrases;
• severe apathy;
• delusions and hallucinations;

Signs of low-grade schizophrenia in women

Sluggish schizophrenia in women has the same symptoms as in men, but in a less pronounced form. The disease debuts later, does not develop so rapidly, and the personality defect is slightly expressed. Treatment is more successful. Symptoms of low-grade schizophrenia in women:

1. Appearance: hairstyle, clothes, makeup undergo changes. The woman becomes sloppy, rarely washes, begins to put on vulgar make-up and dress, or completely neglects herself.
2. Household chores cease to interest the woman; she may begin to bring various rubbish home and store it away.
3. Mood swings throughout the day: hysterics (laughter, sobs), aggression or sadness, tearfulness.
4. Paroxysmal course of the disease.

Psychiatrists are never in a hurry to make a diagnosis of schizophrenia. It can be equated to a sentence. Therefore, you need to know 7 symptoms and signs of sluggish schizophrenia in order to promptly contact a competent specialist for help.

Causes

Currently, the causes of schizophrenia have not been established. Scientists are only putting forward their assumptions. Therefore, this disease is considered multifactorial.

The first factor is based on genetics. Let’s say that if at the birth of a child the parents suffer from schizophrenia, then the risk of transmission is fifty-fifty. If only one of the parents is sick, then the chance of transmitting a (congenital) disease is sharply reduced to almost twelve percent. This indicates the emergence of a predisposition to the disease. Predisposition does not apply to diseases. Pathology may appear after a certain period of time. This time is influenced by factors such as:

1. Parents' health.
2. Drug use.
3. Consumption of alcoholic beverages and many other factors.

The second group is biochemical. It is based on the fact that its factors, in the course of the disease, can cause another disease called psychosis.

Main features

If you run this disease, then it is almost impossible to cure it. Currently, there is one opinion that schizophrenia has initial symptoms in the form of hallucinations. But in fact, they can manifest themselves in various forms:

1. Disturbance in the emotional system.
2. A sharp change in life interests.
3. The emergence of fears and so on.

The 7 signs of low-grade schizophrenia include:

1. Gradual decrease in physical and intellectual activity.
2. Self-containment.
3. Mood swings.
4. Impaired perception of the external and internal worlds.
5. There is no logic.
6. Belief in unreal things.
7. Deception of perception.

Symptom groups

Due to the above, all symptoms of low-grade schizophrenia can be divided into two groups:

1. Productive factors.
2. Negative factors.

The most problematic are the negative factors. This group is based on problems such as lack of emotions when experiencing extreme situations and interruptions in thinking. Some psychologists are able to identify schizophrenia even after communicating with the patient. This diagnosis will be prompted by disturbances in speech and thinking.

How quickly can a disease be identified?

If in the family in which the child grew up there were constantly scandals or some kind of conflict, then the cause of schizophrenia could even be, for example, the loss of a job. Symptoms of low-grade schizophrenia appear a few days after the incident. The first sign is an immediate change in a person’s behavior.

Stages

The progression of flaccid schizophrenia occurs in stages. The following stages are distinguished:

1. Debut (or latent stage) – has blurred and mild symptoms, and therefore the course may go unnoticed even by the patient’s closest people. The following manifestations are typical:

• persistent affects;
• prolonged hypomania;
• somatized depression.

This stage often occurs during puberty. Among teenagers, attempts to avoid communication and refusal to leave the house are possible.

1. Manifest (or active) stage - characterized by an increase clinical symptoms diseases. During this stage, oddities in human behavior become noticeable. However, they are not yet perceived by others as signs of illness, due to the absence of hallucinations and delusions. Meanwhile, the patient begins to experience panic attacks, and various phobias arise. In order to overcome them, a person begins to resort to certain rituals and double-checks (cleanliness of the body, clothes, etc.).
2. Stabilization - all attenuation occurs clinical symptoms, manifested in the previous stage. The patient's behavior becomes completely normal. The duration of this stage can be very long.

Kinds

If we take into account the stage of the disease, as well as some of its manifestations, then we can distinguish two types of sluggish schizophrenia.

1. Neurosis-like.
2. Psychopathic.

The difference between these two types is that for the neurosis-like type, phobic disorders are more characteristic. They manifest themselves in obsessive fears caused by a variety of factors, and often completely unfounded. This is especially often manifested in the fear of being in society and the desire to constantly be at home. Such patients are very afraid various infections Therefore, they most often isolate themselves from any society. The process itself occurs gradually and often unnoticed by others and the patient himself.

In another type of sluggish schizophrenia - psychopath-like - the most striking symptom is not fear, but depression - that is, a stable negative emotional background over a long period of time, as well as a gradually developing depersonalization of his personality. This entire set of symptoms is usually called flattening of affect. The patient stops striving to contact other people; he looks at himself as if from the outside, constantly evaluating his actions and talking to himself. He ceases to recognize himself as the person he is. This, for example, manifests itself in the fact that he ceases to recognize his reflection in the mirror, proving that this is a completely different person.

The theory of human substitution often appears in this issue. Such people lack any emotional reaction to the surrounding situation, and over time they begin to lead an almost vegetal lifestyle in emotional terms. Also, this variety may be characterized by a desire for wandering and gathering, a particularly strong love for animals, with which such people seek to replace their need for contact with people.

Diagnostics

Diagnosing the low-grade form of schizophrenia is a very difficult task, which often requires very long observations that can last indefinitely. And even in this case, one should not rush to a final diagnosis.

There are two types of deviations from which it is difficult to distinguish sluggish schizophrenia: borderline states - various types of psychopathy, neurotic deviations and similar diseases. Manifestations of progressive schizophrenia (neurosis-like and psychopath-like) are also possible. As already mentioned, the disease is very difficult to diagnose. If it is impossible to make an indisputable diagnosis in this situation, then it is better to give preference to something that is different from this disease and begin treatment of the patient without stopping monitoring him. There have been cases when a patient was treated for neurosis for 4-8 years and only after that time received a diagnosis of “sluggish schizophrenia.”

The same applies to doubts in differential diagnosis with other types of schizophrenia. In this case, it is better to give preference to other types of this disease and use necessary methods treatment.

Treatment

The goal of treatment for a diagnosis of sluggish schizophrenia is to achieve stable remission, with constant maintenance therapy. Treatment consists of taking medications. The medication prescribed by your doctor should be taken regularly. Only with strict adherence to the treatment regimen is it possible to achieve positive results. The following types of drug treatment are distinguished:

• Traditional antipsychotics.

The action is carried out by blocking dopamine receptors. The choice of drug is based on the patient's condition, the severity of side effects, and also depends on the route of administration. These drugs include the following drugs: Haloperidol, Chlorpromazine, Thiotixene, etc.

• Second generation neuroleptics.

They affect the activity of dopamine and serotonin receptors. The advantage of these drugs is that they have less side effects. The highest effectiveness in relation to the symptoms of the disease remains an open question. These include drugs: Olanzapine, Ziprasidone, Risperidone, Aripiprazole, etc. When taking drugs from this group, there is a need to monitor the patient’s body weight, as well as to monitor the appearance of signs of type 2 diabetes.

Social support

In addition to drug therapy, there is a great need for sick people to provide social support. It is mandatory to attend various trainings and programs whose objectives are aimed at rehabilitation. Such activities allow patients:

• provide independent self-care;
• feel comfortable in society;
• continue work activities.

Collaboration

In the treatment of low-grade schizophrenia it is very important A complex approach. The help of a psychologist, psychotherapist and social workers is required. Also, close people should provide proper support, without ignoring the patient’s problems. Hospitalization may be necessary at the manifest stage of the disease. Do not neglect this doctor's prescription. Involvement in creativity, visiting various art therapy sessions and cultural places also has a beneficial effect on the condition of patients. It is not recommended to interfere with the self-realization of the patient if he shows interest in creativity. A person with a disease should not be hidden from society or embarrassed about it.

Features of sluggish schizophrenia in women and men

Today, medicine knows the main features of schizophrenia, which are the same in both men and women.

• A decrease in a person’s emotionality and the appearance of indifference to the world around him.
• The desire to close yourself off from the people around you and isolate yourself from the world in any way.
• An indifferent attitude towards one’s former interests and concentration of attention on only one narrow area.
• Inability to adapt to the environment and its changes.

Sluggish schizophrenia in men greatly reduces the emotional response to events or phenomena occurring in their lives.

In some cases, a person may begin to utter completely incoherent nonsense or will see hallucinations. There are also significant increases in speech, speech becomes incoherent and illogical.

The signs of low-grade schizophrenia in women are similar to those in men, but there are some other features. A patient with schizophrenia may experience rapid mood swings to the opposite, as well as a desire to bring absolutely unnecessary things into her home. There is also a strong change in the choice of clothing and makeup. A woman can wear very bright makeup or, on the contrary, become unkempt.

Sluggish schizophrenia is a variant of the disease characterized by a relatively favorable course, the gradual development of personality changes that do not reach the depth of final states, against the background of which neurosis-like (obsessive, phobic, compulsive, conversion), psychopathic-like, affective and, less often, erased paranoid disorders are found.

The existence of slowly and relatively favorably developing psychoses of an endogenous nature was reflected in the literature long before the dissemination of E. Kraepelin’s concept of dementia praecox.

The study of erased, latent forms of schizophrenia began with the research of E. Bleuler (1911).

Subsequently, descriptions of relatively benign forms corresponding to the concept of low-grade schizophrenia appeared in the literature under various names. The most famous of them are “mild schizophrenia” [Kronfeld A.S., 1928], “microprocessual”, “micropsychotic” [Goldenberg S.I., 1934], “rudimentary”, “sanatorium” [Kannabikh Yu.V., Liozner S.A., 1934], “depreciated”, “abortive”, “prephase of schizophrenia” [Yudin T.I., 1941], “slow-flowing” [Ozeretskovsky D.S., 1950]gj “subclinical”, “preschizophrenia ", "non-regressive", "latent", "pseudo-neurotic schizophrenia" [Kaplan G.I., Sadok B.J., 1994], "schizophrenia with obsessive-compulsive disorders".

V. O. Ackerman (1935) spoke of slowly developing schizophrenia with a “creeping” progression.

In American psychiatry throughout the 50-60s, the problem of “pseudoneurotic schizophrenia” was intensively developed. In the next decade and a half, the attention of researchers to this problem was associated with the clinical and genetic study of schizophrenia spectrum disorders (the concept of “borderline schizophrenia” by D. Rosenthal, S. Kety, P. Wender, 1968).

In domestic psychiatry, the study of favorable, mild forms of schizophrenia has a long tradition. It is enough to point out the studies of L. M. Rosenstein (1933), B. D. Friedman (1933), N. P. Brukhansky (1934), G. E. Sukhareva (1959), O. V. Kerbikov (1971), D. E. Melekhova (1963), etc. In the taxonomy of schizophrenia developed by A-V. Snezhnevsky and his colleagues, sluggish schizophrenia acts as an independent form [Nadzharov R. A., Smulevich A. B., 1983; Smulevich A. B., 1987, 1996].

Conditions corresponding to various variants of sluggish schizophrenia (neurosis-like, psychopathic-like, “poor in symptoms”), in ICD-10, are allocated outside the heading “Schizophrenia” (F20), which unites psychotic forms of the disease, and are considered under the heading “Schizotypal disorder” (F21).

Data on the prevalence of sluggish schizophrenia among the Russian population vary from 1.44 [Gorbatsevich P. A., 1990] to 4.17 per 1000 population [Zharikov N. M., Liberman Yu. I., Levit V. G., 1973] . Patients diagnosed with sluggish schizophrenia range from 16.9-20.4% [Ulanov Yu. I., 1991] to 28.5-34.9% [Yastrebov V. S., 1987] of all registered patients with schizophrenia.

The idea of ​​the biological commonality of sluggish and manifest forms of schizophrenia is based on data on the accumulation in families of probands with sluggish schizophrenia of schizophrenia spectrum disorders - manifest and erased forms, as well as schizoid disorders. A feature of sluggish schizophrenia is the homotopic nature of mental pathology among affected relatives, namely the accumulation of forms similar to the disease of the proband (secondary cases of sluggish schizophrenia) [Dubnitskaya E. B., 1987].

When identifying variants of sluggish schizophrenia based on the predominance of axial disorders in the disease picture - negative (“simple deficit”, according to N. Eu, 1950] or pathologically productive - the features of the “family psychopathic predisposition” are taken into account, the existence of which in the form of a schizoid constitution in families of patients with schizophrenia was first postulated by E. Kahn (1923).

The inherent aggravation of schizophrenia by psychopathy such as schizoidia (“poor schizoids” by T.I. Yudin, “degenerate eccentrics” by L. Binswanger) also extends to sluggish simple schizophrenia. Accordingly, this option, in which the structure of family burden, including psychopathic predisposition, is completely determined by schizophrenia spectrum disorders, is assessed as basic. But low-grade schizophrenia has a genetic affinity with the circle borderline states. In accordance with this, two other variants are identified, each of which reveals a correspondence between the phenotypic characteristics of the probands’ disease and the preferred type of constitutional mental pathology in families. Thus, in cases of sluggish schizophrenia with obsessive-phobic disorders, there is an accumulation of cases of psychasthenic (anankastic) psychopathy among the close relatives of patients, and in schizophrenia with hysterical disorders - hysterical psychopathy.

In accordance with the presented data, a hypothesis was formulated [Smulevich A.B., Dubnitskaya E.B., 1994], according to which susceptibility to the development of sluggish schizophrenia is determined by two genetically determined axes - procedural (schizophrenic) and constitutional (Fig. 29).

Rice. 29. Structure of family burden in low-grade schizophrenia. 1 - simple schizophrenia (basic variant); 2 - schizophrenia with obsessive-phobic disorders; 3 - schizophrenia with hysterical disorders. The wide line denotes the schizophrenic (procedural) axis, the narrow line the constitutional axis of family burden.

Clinical manifestations. Sluggish schizophrenia, as well as other forms of schizophrenic psychoses, can develop continuously or in the form of attacks. However, the typological division of sluggish schizophrenia according to this principle would not correspond to clinical reality, since a distinctive feature of the development of the disease in most cases is the combination of attacks with a sluggish continuous course.

Subject to the general patterns of the course of endogenous psychoses (latent stage, period of full development of the disease, period of stabilization), sluggish schizophrenia also has its own “logic of development”. The main clinical features of sluggish schizophrenia: 1) a long latent period with subsequent activation of the disease at distant stages of the pathological process; 2) a tendency towards a gradual modification of symptoms from the least differentiated in terms of nosological specificity (in the latent period) to those preferable for the endogenous disease (in the active period, in the stabilization period); 3) invariance series; and psychopathological disorders (axial symptoms), which represent a single chain of disorders, the natural modification of which is closely related to both the signs of generalization of the pathological process and the level of negative changes.

Axial symptoms (obsessions, phobias, overvalued formations, etc.), appearing in combination with defect phenomena, determine the clinical picture and persist (despite the change of syndromes) throughout the course of the disease

Within the framework of sluggish schizophrenia, variants with a predominance of pathologically productive ones are distinguished - pseudoneurotic, pseudopsychopathic (obsessive-phobic, hysterical, depersonalization) and negative disorders. The last option - sluggish simple schizophrenia - is one of the symptom-poor forms [Nadzharov R. A., Smulevich A. B., 1983]. It is often determined by the predominance of asthenic disorders (schizoasthenia, according to N. Eu).

Sluggish schizophrenia with obsessive-phobic disorders [obsessive schizophrenia, according to E. Hollander, C. M. Wong (1955), schizophrenia with obsessive-compulsive disorder, according to G. Zohar (1996); schizoobsessive disorder, according to G. Zohar (1998)] includes a wide range of anxiety-phobic manifestations and obsessions. The clinical picture of the latter is characterized by a complex structure of psychopathological syndromes, formed both due to the simultaneous manifestation of several phenomena of the obsessive-phobic series, and due to the addition of ideo-obsessive disorders [Korsakov S. S., 1913; Kraft-Ebing K., 1879], including rudimentary violations of more severe registers. Among such symptom complexes may be dissociative disorders, phenomena of auto- and allopsychic depersonalization, manifesting within panic attacks; overvalued and sensory hypochondria, complicating the course of agoraphobia; sensitive ideas of relationship, joining social phobia; delusions of harm and persecution that complicate the picture of mysophobia; catatonic stereotypies, gradually replacing ritual actions.

The progression of the disease in its first stages is manifested by a rapid increase in the frequency, intensity and duration of panic attacks, as well as a reduction in the duration of interictal intervals. Subsequently, one of the most pathognomonic signs of the procedural nature of suffering is the steady increase in manifestations of avoidant behavior, clinically realized in the form of various protective rituals and controlling actions. Gradually displacing the primary component of obsessive disorders - phobias and obsessions, rituals acquire the character of complex, unusual, fanciful habits, actions, mental operations (repetition of certain syllables, words, sounds, obsessive counting, etc.), sometimes very reminiscent of spells.

Among anxiety-phobic disorders, panic attacks most often dominate. A distinctive feature of the dynamics of these pseudoneurotic manifestations acting within the framework of an endogenous disease, which was pointed out by Yu. V. Kannabikh (1935), is the suddenness of manifestation and persistent course. At the same time, the atypicality of panic attacks attracts attention. They are usually protracted and either combined with symptoms of generalized anxiety, fear of loss of control over oneself, insanity, severe dissociative disorders, or occur with a predominance of somatovegetative disorders (like dysaesthetic crises), combined with disturbances in the general sense of the body, a feeling of sudden muscle weakness, senesthesia, senestopathies. The complication of the disease picture is manifested by the rapid addition of agoraphobia, accompanied by a complex system of protective rituals. It is also possible to transform individual phobias (fear of movement in transport or open spaces) into panagoraphobia, when avoidant behavior not only limits movement, but also extends to any situations in which the patient may find himself without help [Kolyutskaya E. V., Gushansky N. E. ., 1998].

Among other phobias in a number of pseudoneurotic disorders, fear of an external (“extracorporeal”) threat is often noted: the penetration into the body of various harmful agents - toxic substances, pathogenic bacteria, sharp objects - needles, glass fragments, etc. Like agoraphobia, phobias of external threat are accompanied by defensive actions (complex, sometimes lasting for hours, manipulations that prevent contact with “contaminated” objects, thorough treatment or even disinfection of clothing that has come into contact with street dust, etc.). “Rituals” of this kind, gradually occupying a leading position in the clinical picture, completely determine the behavior of patients, and sometimes lead to complete isolation from society. Avoiding potential danger (interaction with “harmful” substances or pathogenic agents), patients quit work or school, do not leave the house for months, move away even from their closest relatives and feel safe only within their own room.

Phobias that form within the framework of protracted (from several months to several years) attacks, manifesting together with affective disorders, in contrast to anxiety-phobic disorders that constitute a meaningful (denotative) complex of cyclothymic phases (obsessive ideas of low value, anxious fears of one’s own inadequacy), do not form such close - syndromic connections with depressive symptoms and subsequently manifest their own developmental stereotype, not directly related to the dynamics of affective manifestations [Andryushchenko A.V., 1994]. The structure of phobias that determine the picture of such attacks is polymorphic. When somatized anxiety predominates among the manifestations of depression, the fear of death combined with panic attacks (heart attack phobia, stroke phobia), the fear of being helpless in a dangerous situation, the fear of penetration of pathogenic bacteria, foreign objects, etc. into the body may come to the fore.

In other cases, occurring with a picture of depersonalization and anxious depression, phobias of contrasting content, fear of insanity, loss of control over oneself, fear of causing harm to oneself or others - to commit murder or suicide (stab, throw a child from a balcony, hang oneself, jump out of a window) prevail ). Suicidal and homicidal phobias are usually accompanied by vivid figurative representations of tragic scenes that may follow if alarming fears are realized. As part of the attacks, acute paroxysms of phobias can also be observed, which are characterized by absolute lack of motivation, abstraction, and sometimes metaphysical content.

Obsessions in low-grade schizophrenia often manifest against the background of negative changes that are already forming (oligophrenia-like, pseudo-organic defect, defect of the “Ferschroben” type with autistic isolation and emotional impoverishment). At the same time, abstract obsessions are observed [Snezhnevsky A.V., 1983] of the type of obsessive philosophizing with a tendency to resolve useless or insoluble questions, repeated attempts to reveal the meaning of a particular expression, the etymology of the term, etc. However, most often obsessive doubts are formed in completeness, completeness of actions, which come down to rituals and double-checks. At the same time, patients are forced to repeat the same operations (position objects strictly symmetrically on the desk, turn off the water tap many times, wash their hands, slam the elevator door, etc.).

Obsessive doubts about the cleanliness of one’s own body, clothing, and surrounding objects [Efremova M. E., 1998], as a rule, are accompanied by hours-long ritual actions aimed at “cleansing” from imaginary dirt. Obsessive doubts about the presence of a serious incurable disease (most often cancer) lead to repeated examinations by various specialists, repeated palpating of those parts of the body where the suspected tumor could be localized.

Obsessions that develop or worsen during attacks can occur according to the type of “insanity of doubt” - folie du doute. Against the background of an anxious state with insomnia and ideational agitation, constant doubts appear about actions implemented in the past, the correctness of actions already committed. The picture of attacks can be determined by contrasting obsessions such as doubts about committing violence or murder [Dorozhenok I. Yu., 1998], which manifest themselves at the height of the state in the form of “taking the incredible for reality.” When the state generalizes, fears and hesitations in connection with upcoming actions are also added, reaching the level of ambivalence and even ambition.

As the endogenous process develops, obsessions quickly lose their previous affective coloring and acquire features of inertia and monotony. Their content is becoming more and more ridiculous, even losing external signs psychological understandability. In particular, compulsive disorders in the later stages are close to motor stereotypies and are accompanied in some cases by self-harmful behavior (biting hands, scratching the skin, gouging out the eyes, pulling the larynx). These features of obsessive disorders in low-grade schizophrenia distinguish them from obsessions in borderline states. Negative changes noted at the onset of the disease appear most clearly in its later stages and significantly reduce the social functioning of patients. At the same time, previously unusual psychopath-like manifestations of the anankastic circle are formed - rigidity, conservatism, exaggerated straightforwardness of judgment.

Sluggish schizophrenia with symptoms of depersonalization [Nadzharov R. A., Smulevich A. B., 1983]. Clinical picture This form of the disease is determined by the phenomena of alienation that appear in various spheres of self-consciousness (auto-, allo- and somatopsychic depersonalization). At the same time, depersonalization extends primarily to higher differentiated emotions, the sphere of the autopsyche (consciousness of changes in the inner world, mental impoverishment) and is accompanied by a decrease in vitality, initiative and activity.

Premorbidly, patients exhibit features of borderline (increased impressionability, emotional instability, vivid imagination, affective lability, vulnerability to stress) or schizoid personality disorder (withdrawal, selective sensitivity to internal conflicts, coldness towards others). They are characterized by hypertrophy and instability of the sphere of self-awareness, manifested both in a tendency to reflection, long-term retention of impressions, and in a tendency to form transient depersonalization episodes - deja vu, etc. [Vorobiev V. Yu., 1971; Ilyina N.A., 1998].

At the onset of the disease, the phenomena of neurotic depersonalization predominate - heightened introspection, complaints about the loss of “feeling tone”, the disappearance of brightness and clarity of perception of the environment, which is, according to J. Berze (1926), one of the significant signs of the initial stages of the process. In the paroxysmal course of the disease, disorders of self-awareness usually appear within the affective phases - anxious-apathetic depression according to F. Fanai (1973). Certain depersonalization symptom complexes (a paroxysmal feeling of altered mental functions with fear of loss of self-control) already appear in the structure of acute anxiety attacks (panic attacks). With a shallow level of affective disorders (dysthymia, hysteroid dysphoria), partial anesthetic disorders predominate: detached perception of objective reality, lack of a sense of appropriation and personification, a feeling of loss of flexibility and intellectual acuity [Ilyina NA., 1998]. As depression reverses, there is a tendency toward a reduction in depersonalization disorders, although even in remission, disturbances in self-awareness do not completely disappear. Periodically, due to external influences (overwork) or autochthonously, exacerbation of depersonalization phenomena occurs (perception of one’s own face reflected in the mirror as someone else’s, alienation of the surrounding reality, certain sensory functions).

When generalizing depersonalization disorders within the framework of protracted depression, the phenomena of painful anesthesia (anaesthesia psychica dolorosa) come to the fore. The feeling of numbness manifests itself primarily as a loss of emotional resonance. Patients note that painting and music do not evoke the same emotional response in them, and what they read is perceived as cold, bare phrases - there is no empathy, there are no subtle shades of feelings, the ability to feel pleasure and displeasure is lost. The space seems to be flattened, the surrounding world seems changed, frozen, empty.

The phenomena of autopsychic depersonalization [Vorobiev V. Yu., 1971] can reach the degree of complete alienation, loss of their self. Patients claim that their mental self has gone out: they have lost contact with past life, they don’t know what they were like before, they don’t seem to be affected by what’s happening around them. In some cases, the consciousness of the activity of the Self is also disrupted - all actions are perceived as something mechanical, meaningless, alien. The feeling of loss of connection with others, noted even at the onset of the disease, intensifies to a feeling of complete misunderstanding of people’s behavior and the relationships between them. The consciousness of the identity of the Self and the opposition of the consciousness of the Self to the external world are disrupted. The patient ceases to feel himself as a person, looks at himself “from the outside,” experiences a painful dependence on others - he has nothing of his own, his thoughts and actions are mechanically adopted from other people, he only plays out roles, transforms into images that are alien to himself.

As the endogenous process progresses, the phenomena of mental alienation (which are, in principle, reversible) are transformed into the structure of deficiency changes - defective depersonalization. This modification is realized within the framework of the so-called transition syndrome. Symptoms of Depersonalization gradually lose their clarity, physicality, lability and variety of manifestations. The “feeling of incompleteness” comes to the fore, extending both to the sphere emotional life, and on self-awareness in general. Patients recognize themselves as changed, dull, primitive, and note that they have lost their former spiritual subtlety. Alienation of connections with people, which previously appeared in the picture of autopsychic depersonalization, now gives way to true communication difficulties: it is difficult to enter a new team, to grasp the nuances of the situation, to predict the actions of other people. In order to somehow compensate for the feeling of incompleteness of interpersonal contacts, you constantly have to “adjust” to the general mood and follow the interlocutor’s train of thought.

The phenomena of defective depersonalization that develop within the framework of the transition syndrome, along with personality changes characteristic of most patients with schizophrenia (egocentrism, coldness, indifference to the needs of others, even close relatives), are also accompanied by negative manifestations of a special kind, defined in connection with the constant dissatisfaction of patients with their mental activity as "moral hypochondria". Patients concentrate entirely on analyzing the nuances of their mental functioning. Despite the partially restored adaptive capabilities, they strongly emphasize the severity of the damage caused to mental activity. They use all means to demonstrate their mental incompetence: they demand treatment that would lead to a “complete restoration of brain activity”, while showing persistence, seeking various examinations and new medication prescriptions by any means.

For sluggish schizophrenia with hysterical manifestations [Dubnitskaya E. B., 1978] hysterical symptoms take on grotesque, exaggerated forms: rough, stereotyped hysterical reactions, hypertrophied demonstrativeness, affectation and flirtatiousness with mannerisms, contractures lasting for months, hyperkinesis, persistent aphonia, etc. Hysterical disorders, as a rule, act in complex comorbid relationships with phobias, obsessive drives, vivid mastering ideas and senesto-hypochondriacal symptom complexes.

The development of protracted, sometimes lasting more than six months, hysterical psychoses is characteristic. The picture of psychosis is dominated by generalized (mainly dissociative) hysterical disorders: confusion, hallucinations of the imagination with mystical visions and voices, motor agitation or stupor, convulsive hysterical paroxysms. The phenomena of disturbed consciousness usually quickly undergo reverse development, and the remaining signs of psychosis show persistence, unusual for psychogenically caused hysterical symptoms, and a number of features that bring them closer to disorders of more severe registers. For example, deceptions of perception, while maintaining similarities with hallucinations of the imagination (imagery, variability of content), gradually acquire features characteristic of pseudohallucinatory disorders - violence and involuntary occurrence. A tendency toward “magical thinking” appears, hysterical motor disorders lose their demonstrativeness and expressiveness, becoming closer to subcatatonic disorders.

At later stages of the disease (stabilization period), gross psychopathic disorders (deceit, adventurism, vagrancy) and changes typical for schizophrenia (autism, decreased productivity, adaptation difficulties, loss of contacts) appear more and more clearly in the clinical picture. Over the years, patients most often take on the appearance of lonely eccentrics, degraded, but loudly dressed women who abuse cosmetics.

For indolent simple schizophrenia [Nadzharov R. A., 1972] manifestations of the latent period correspond to the debut of negative schizophrenia with a slow deepening of mental deficiency (decreased initiative, activity, emotional leveling). In the active period, the phenomena of autochthonous asthenia with impaired self-awareness of activity predominate. Among other positive symptom complexes, in the foreground are disorders of the anergic pole with extreme poverty, fragmentation and monotony of manifestations. Depressive disorders related to the circle of negative affectivity arise most consistently - apathetic, asthenic depression with poor symptoms and an undramatic clinical picture. Phase affective disorders occur with increased mental and physical asthenia, depressed, gloomy mood, anhedonia and alienation phenomena (a feeling of indifference, detachment from the environment, inability to experience joy, pleasure and interest in life), senesthesia and local senestopathies. As the disease progresses, slowness, passivity, rigidity increase, as well as signs of mental insolvency - mental fatigue, complaints of difficulty concentrating, influxes, confusion and interruptions of thoughts.

During the period of stabilization, a persistent asthenic defect is formed with a tendency to self-sparing, decreased tolerance to stress, when any additional effort leads to disorganization of mental activity and a drop in productivity. Moreover, in contrast to grossly progressive forms of schizophrenia with a similar picture, we are talking about a type of processual changes in which the disease, in the words of F. Mauz (1930), “reduces personality, weakens it, but leads to inactivity only certain of its structures.” Despite the emotional devastation and narrowing of their range of interests, patients show no signs of behavioral regression, are outwardly quite orderly, and possess the necessary practical and simple professional skills.

Diagnosis. The process of diagnosing sluggish schizophrenia requires an integral approach, based not on individual manifestations of the disease, but on the totality of all clinical signs. The diagnostic analysis takes into account information about family history (cases of “familial” schizophrenia), premorbid characteristics, development in childhood, puberty and adolescence. Of great importance for establishing the endogenous-processual nature of painful manifestations are unusual or fanciful hobbies discovered during these periods [Lichko A. E., 1985, 1989], as well as sharp, time-limited characterological shifts with professional “breakdown”, changes in the entire life curve and disorders of social adaptation.

In contrast to borderline conditions, in case of process-related pathology, there is a gradual decrease in working capacity associated with a decrease in intellectual activity and initiative. Signs used as clinical criteria when diagnosing sluggish schizophrenia, they are grouped into two main registers: pathologically productive disorders (positive psychopathological symptoms) and negative disorders (manifestations of a defect). The latter are not only obligate for recognizing sluggish schizophrenia, but also determine the final diagnosis, which can be established only if there are clear signs of a defect. This provides for the exclusion of conditions that are determined not so much by the influence of an endogenous process (latent, residual), but rather by “personal-environmental interaction.”

When diagnosing sluggish schizophrenia according to the register of pathologically productive disorders, two rows of psychopathological manifestations are simultaneously taken into account: 1st row - disorders that are preferable to the endogenous process from the moment of formation; 2nd row - disorders that have endogenous-processual transformation in dynamics. The 1st row includes subpsychotic manifestations in the picture of episodic exacerbations: verbal deceptions of a commentary, imperative nature, “calling”, “sounding of thoughts”; general sense hallucinations, haptic hallucinations; rudimentary ideas of influence, pursuit of special significance; autochthonous delusional perception. A number of positive disorders that exhibit a dynamic transformation characteristic of the endogenous process include obsessive-phobic states with a consistent modification of ideo-obsessive disorders (“insanity of doubts,” contrasting phobias) in the direction of ideo-obsessive delusions with ambiguous ritual behavior and abstract content of symptoms; depersonalization states with a gradual worsening of disorders of self-awareness from neurotic to defective depersonalization with gross emotional changes and damage in the auto-psychic sphere; hysterical states with transformation of conversion and dissociative manifestations into senesto-hypochondriacal, subcatatonic, pseudohallucinatory.

Ancillary, but, according to modern European psychiatrists, very significant for diagnosis are expression disorders that give the appearance of patients features of strangeness, eccentricity, and eccentricity; neglect of the rules of personal hygiene: “negligence”, sloppiness of clothing; mannerisms, paramimic expression with a characteristic gaze that avoids the interlocutor; angularity, jerkiness, “hinge” movements; pomposity, suggestiveness of speech with poverty, inadequacy of intonation. The combination of these features of the expressive sphere with the nature of unusualness and foreignness is defined by H. C. Rumke (1958) by the concept of “praecoxgeful” (“praecox feeling” in English terminology).

Schizophrenia occurring in the form of an atypical prolonged pubertal attack

This section describes variants of single-attack, relatively favorably developing schizophrenia with syndromes characteristic of adolescence - heboid, special supervaluable formations, dysmorphophobia with psychasthenic-like disorders.

In adolescence, significant changes occur in the reactivity of the body, its neuroendocrine and immunobiological systems, which, of course, cannot but have a profound impact on the occurrence, course and outcome of schizophrenia. In addition, the incompleteness of the evolution of brain systems, immaturity of the psyche and the presence of special crisis pubertal mental manifestations influence the formation of the clinical picture of the disease.

Puberty covers the age range from 11 to 20-23 years. It includes early puberty (adolescence), puberty and late puberty, or adolescence itself, periods. The main characteristics that determine the mental manifestations of the pubertal period: firstly, pronounced instability and inconsistency of individual aspects of the neuropsychic makeup, the leading role of the affective sphere, emotional lability - “pubertal mood lability”; secondly, the desire for independence, independence with doubts and even rejection of previous authorities and especially a negativistic attitude towards the authority of people from the immediate environment - family, teachers, etc. - a period of “denial” [Smirnov V. E., 1929; Busemann A., 1927], “protest against fathers”, “striving for independence”; thirdly, an increased interest in one’s physical and mental self with special sensitivity and vulnerability (about any of one’s shortcomings or failures), leading in some cases to fixation on one’s external data, in others on the problem of self-awareness up to the symptom complex of depersonalization or, on the contrary, to a pronounced desire for self-improvement, creativity in various areas activities with the orientation of thinking towards abstract problems and signs of maturation of drives - the period of “philosophy”, “metaphysics”.

When schizophrenia debuts in adolescence and especially with its slow, relatively favorable development, the described pubertal crisis manifestations not only persist and have a clear dynamics towards their distortion, but often become decisive for the development of the clinical features of the disease as a whole. We are talking about the formation of special symptom complexes specific to adolescence, among which the most characteristic are heboid, “youthful metaphysical intoxication (special super-valuable formations),” dysmorphophobic and psychasthenic-like [Tsutsulkovskaya M. Ya., Panteleeva G. P., 1986].

Long-term study of juvenile low-progressive schizophrenia [Tsutsulkovskaya M. Ya., 1979; Bilzho A.G., 1987] showed that 10-15 years after the first hospitalization in adolescence, the majority of patients gradually experience compensation for the condition with a reduction in psychopathological phenomena and the identification of only mildly expressed signs of a personality defect, which practically do not interfere with social labor adaptation. All this indicates pronounced features this option juvenile schizophrenia, determining its position in the general taxonomy of forms of the latter. In these cases, there is every reason to talk about atypical protracted pubertal schizophrenic attacks [Nadzharov R. A., 1977] as a variant of the disease close to sluggish schizophrenia.

The form of schizophrenia under consideration has a certain developmental stereotype, the stages of which coincide with the stages of normal maturation.

The period of initial manifestations of the disease begins at the age of 12-15 years. It is characterized by a sharpening of character traits, the appearance of autochthonous atypical bipolar affective disorders, sometimes of a continuous nature, with the presence of a dysphoric shade of depression, dissatisfaction with oneself and others, or signs of agitation with unproductivity, lack of desire for contacts - in hypomania. All this is combined with the appearance of opposition to the environment, the desire for self-affirmation, behavioral disorders, and conflict. It is possible that undeveloped dysmorphophobic ideas of an overvalued nature may appear. Sometimes patients’ attention is fixed on the awareness of changes in their physical and mental “I”, there is a tendency towards introspection and difficulties in contacts with others or a dominance of interests in the field of “abstract” problems.

The next stage, usually corresponding to the age of 16-20 years, is characterized by a rapid increase in mental disorders and their greatest severity. It is during this period that the need for hospitalization arises. mental asylum. In the status of patients, acute psychotic phenomena are noted, although they are of a transient and rudimentary nature: onirism, agitation, ideational disturbances, mentism, severe sleep disturbances, individual hypnagogic and reflex hallucinations, and individual hallucinations of the imagination. At this stage, heboid, dysmorphophobic, pseudopsychasthenic syndromes and the syndrome of “metaphysical intoxication” appear in their most complete form and completely determine the condition of the patients. But at the same time, in their clinical characteristics, they differ in significant features from outwardly similar manifestations characteristic of pathologically occurring pubertal crises. For a number of years, the condition remains relatively stable, without visible dynamics, characterized by the uniformity of painful manifestations, without a noticeable tendency to complicate psychopathological symptoms and even with periods of their weakening and the preservation of psychopathic, overvalued and affective registers of disorders. When contacting such patients, one sometimes gets the impression that they have pronounced negative changes, a severe schizophrenic defect.

Between 20 and 25 years (in some patients later, in others earlier) gradual compensation of the condition occurs with a noticeable reduction or complete disappearance of the described disorders and restoration of social and labor adaptation. As a rule, at this stage there are no longer any signs of progression of the disease process, in particular its repeated exacerbations. Social compensation and professional growth have also increased over the years.

A feature of the long-term period of the disease, regardless of the predominant syndrome at the previous stage of the disease, is the relatively shallow degree of negative changes. If during the period of full-blown disorders the impression of a deep mental defect was created - emotional flattening, moral dullness, gross manifestations of infantilism, a pronounced drop in energy capabilities, then as productive disorders were reduced, personality changes usually turned out to be not so pronounced, limited only in some patients to a loss of breadth of interests, a decrease mental activity, the emergence of a purely rational attitude towards loved ones, with the need for care, and some isolation in the family circle. In some patients, signs of infantilism came to the fore, manifested in impracticality, dependence on loved ones, emotional immaturity, weakness of desires with a good level of mental productivity; in others, schizoid personality traits prevailed with traits of autism and eccentricity, which, however, did not interfere with a high level of professional growth and social adaptation.

Studies of premorbid patients, the characteristics of their early development, the study of childhood crisis periods, and personality traits in childhood made it possible to discover a high frequency of abnormal personality traits with phenomena of dysontogenesis [Pekunova L. G., 1974]. Analysis of the family background showed that in families of patients there is a significant accumulation of sluggish and attack-like forms of schizophrenia in parents and siblings [Shenderova V.L., 1975]. Relatives of patients often also had similarities with the patients in their premorbid personality.

Thus, the form of schizophrenia in the form of prolonged atypical pubertal attacks should be classified as a special group in the taxonomy of forms of schizophrenia, in the genesis of which, with the dominant role of pubertal crisis mechanisms, constitutional genetic factors are of great importance. There is reason to believe that we are talking not only about the pathoplastic, but also about the pathogenetic role of puberty in the genesis of these atypical pubertal forms.

In view of the possibility of significant compensation for the condition of patients after puberty, with a high level of their professional growth, social and labor adaptation, issues that limit the subsequent social growth of patients (transfer to disability, restrictions on admission to a university, expulsion from a university, etc.) .). The possibility of a high level of compensation for these atypical pubertal attacks requires a special discussion of the social aspects of their clinical diagnosis, since these patients socially should not fit into the general group of patients with schizophrenia along with patients with severe progressive forms.

Among the atypical pubertal schizophrenic attacks, the following 3 types are distinguished: heboid, with the syndrome of “youthful metaphysical intoxication,” with dysmorphophobic and psychasthenic-like disorders.

Conditions corresponding to different variants of schizophrenia with a course in the form of an atypical protracted pubertal attack are taken out of the ICD-10 section “Schizophrenia” (F20), which unites psychotic forms of the disease, and are considered in the section “Schizotypal disorder” (F21). In this case, it is possible to indicate the corresponding syndrome with the second code: F21, F60.2 (heboid); F21, F60.0 (“metaphysical intoxication”); F21, F45.2 (dysmorphophobic); F21, F60.6 (psychasthenic-like).

In the Recommendations of the Ministry of Health of the Russian Federation for the use of ICD-10 in Russia, atypical protracted pubertal seizures are highlighted in the section “Schizotypal disorder” (F21) as a psychopathic variant of sluggish schizophrenia (F21.4) using the above second code to highlight the corresponding clinical syndrome that dominates the picture of protracted pubertal attack. Thus, the heboid variant is coded as F21.4, F60.2; option with “metaphysical intoxication” - F21.4, F60.0; dysmorphophobic variant -F21.4, F45.2; psychasthenic variant - F21.4, F60.6.

Heboid attack should be defined as a mental disorder that occurs in adolescence, characterized by a pathological exaggeration and modification to a psychotic level of psychological pubertal properties with a predominance of affective-volitional disorders, including drives, leading to behavior contrary to generally accepted norms and pronounced maladaptation in society [Panteleeva G. P. ., 1973, 1986].

The first (initial) stage in the development of the heboid state, in which the disease debuts, occurs mainly in the first half of puberty - the age of 11-15 years. The duration of this stage in most patients is 1-3 years.

Initial signs of the disease: the appearance in patients of previously unusual psychopathic features of the schizoid and excitable circle, perverted emotional reactions and drives. Signs of “flawed” personality of the schizophrenic type also develop.

In some cases, an exaggeratedly skeptical attitude towards the environment prevails, combined with crude cynicism in judgments about life, a desire for originality, and farce. The behavior of patients begins to be dominated by idleness, separation from common interests with peers, one-sided passions for modern music such as “punk rock”, “heavy metal”, “rap”, etc. Others tend to walk aimlessly along the streets. Patients completely ignore the opinion of relatives on this or that issue, the convenience of the family, and react indifferently even to the death of people close to them. All this indicates that the leading features in the behavior of such patients are weakening self-control and increasing lack of will. In other cases, the clinical picture of the initial stage of the disease is dominated by features of increased irritability, rudeness and lack of harmony with others, which was previously unusual for patients. The stubbornness exhibited by patients is alarming due to its lack of motivation. Patients, despite requests, convictions and even orders, stop cutting their hair, changing their linen, refuse to wash, enter into unnecessary arguments, and argue unnecessarily for hours. In reactions to the environment, inadequate anger, often accompanied by aggression, becomes more and more noticeable. During study sessions, patients become increasingly laziness and absent-mindedness. It is also noteworthy that the patients seem to stop in their mental development: they again begin to be interested in fairy tales, as well as military and “spy” themes of books and films, they get special pleasure from describing scenes of various atrocities, torments, various scandalous stories, become deceitful, etc.

Simultaneously with the described changes, atypical, erased bipolar affective disorders are revealed. They more often appear in the form of dysthymia with a predominance of dissatisfaction with oneself, a desire for loneliness, and an unwillingness to do anything. Sometimes hypomanic states also occur, which in these cases are characterized by periods of unexpected rudeness and conflict against a background of carelessness.

The second stage in the dynamics of heboid manifestations is characterized by the manifestation of the heboid state and develops in most cases at the age of 15-17 years. During this period, a psychopathic-like development of pubertal disorders occurs, leading to complete decompensation of the condition. The behavior of patients amazes those around them with rudeness, inadequacy and low motivation of actions. The conflict and brutality of the behavior of patients with senseless opposition and total negativism to the generally accepted way of life, elevating everything negative to authority takes on exaggerated features. Ugly and caricatured forms of imitation of style in clothing and manners also appear, which, as a rule, lead to boundless eccentricity and pretentiousness of appearance and behavior in general, deliberate looseness, empty posing and clowning. In some cases, behavior is dominated by a negativistic attitude towards close relatives with unmotivated hostility and hatred towards them, persistent terrorization of them with unfounded claims, sophisticated cruelty and causeless aggression. Quite typical are the persistent desire to resolve abstract problems in the absence of appropriate knowledge and understanding of them, while simultaneously moving away from any really significant, useful activity. Increasing irritability is often accompanied by grotesque, monotonous hysterical reactions, which in their manifestations often approach unmotivated impulsive outbursts of rage and aggression.

Despite the preservation of intellectual abilities at this stage of development of the heboid state, most patients, due to sharp decline academic progress, they leave school or in the first years of college and lead an idle lifestyle for several years; in some cases, without hesitation, they go to other cities to “experience life”, easily fall under the influence of antisocial personalities and commit offenses, join various religious sects (mainly of a “satanic” orientation).

Often, patients experience disinhibition of sexual desire, excessive consumption of alcoholic beverages and drugs, and gambling. The attraction to any type of activity is determined by perverted emotional reactions, and then the nature of the activity approaches in its content to perverse drives. For example, patients are drawn to descriptions of cruelty, adventurous actions, depict in drawings various unpleasant situations, drunkenness, human deformities, etc.

Since manifestations of the heboid state can imitate negative disorders, it is difficult to judge the true severity of personality changes during this period. Nevertheless, the “schizophrenic” coloring of the behavior of patients in general appears very clearly in the form of inadequacy of actions, their lack of motivation, incomprehensibility, strangeness, monotony, as well as pretentiousness and absurdity. In the picture of the heboid state, pronounced schizoid features coexist with hysterical elements of panache and demonstrativeness, symptoms of pathological fantasy - with traits of rigidity, manifestations of increased excitability and affective instability - with neurotic and phobic symptoms, disturbances of desire - with disorders of the psychasthenic circle (self-doubt, loss feelings of ease during communication, increased reflection, etc.), phenomena of dysmorphophobia of an obsessive or overvalued nature, with erased senestopathies, unformed ideas of relationship.

Affective disorders during the period under review are of a bipolar phase nature and arise autochthonously. At the same time, they are, as a rule, atypical and the actual thymic component in their structure appears in an extremely erased form. Affective states are characterized by a significant extension over time (from 2-3 months to 2-3 years) and often succeed each other in a continua manner.

Against the background of the described disturbances, in some cases, suspicion occasionally arises with the feeling that something is afoot around, states of pointless fear, sleep disturbances in the form of insomnia or nightmares, and rudimentary phenomena of oneirism. There are episodes of sound and influx of thoughts, a transient feeling of possessing hypnotic power, guessing other people's thoughts with a feeling of involuntary thinking, memories, unusual brightness and illusory perception of the environment, mystical penetration, episodes of depersonalization and derealization, hypnagogic visual representations. All these symptoms in the structure of the heboid state are rudimentary in nature, lasting from several hours to 1-2 days.

The third stage of the heboid state is characterized by a weakening tendency towards further complication of symptoms and stabilization of the condition at the level of the previous stage. From the age of 17-20 years, over the next 2-7 years, the clinical picture and behavior of patients become monotonous, regardless of changes in real conditions and external influences. In these cases, patients remain deaf to those situations that arose as a result of their incorrect behavior (brought to the police, hospitalization, expulsion from an educational institution, dismissal from work, etc.). Their tendency to use alcohol and drugs is also persistent, despite the absence of an irresistible attraction to them (the patients are not amenable to correction, administrative influences, or drug treatment). They easily fall under the influence of antisocial individuals, participate in crimes and antisocial initiatives organized by the latter, and are detained by the police for “hooliganism” and other acts. Signs of mental retardation also become more noticeable (the latter seems to stop at the teenage level, patients “do not grow up”).

During this period, the largest number of hospitalizations due to improper behavior of patients is noted. Treatment in a hospital, in particular the use of antipsychotics, can relieve the heboid condition, but after cessation of treatment, the patients’ condition quickly deteriorates again.

During the third stage, without connection with any external factors Many patients may spontaneously experience an improvement in their mental state, which can last from several days or weeks to one and (rarely) several months. During these periods, patients, in the words of their relatives, become almost “as before.” They start studying, catching up on neglected material, or working. It often seems that signs of emotional dullness disappear. But then the state changes again and heboid disorders of the previous psychopathological structure arise.

The fourth stage in the dynamics of the heboid state is characterized by its gradual reverse development. It lasts on average 1-2 years and occurs at the age of 20-24 years (ranges from 18 to 26 years). At this stage, the polymorphism of heboid disorders gradually decreases, behavioral disorders, unmotivated hostility towards relatives, a tendency to use alcohol and drugs, and unusual hobbies and interests are smoothed out; The “pubertal worldview” loses its clearly oppositional orientation, and then gradually fades away. Signs of weakening self-control remain much longer, which is reflected in episodic alcohol, drug and sexual excesses. Productive symptoms (neurosis-like, dysmorphophobia, etc.) gradually disappear and only a tendency to mild autochthonous mood changes remains.

The social and labor adaptation of patients is significantly improved. They often resume interrupted studies and even begin to master a profession.

As heboid disorders are reduced, it becomes possible to assess personality changes. As a rule, they are not as deep as one might expect. They were limited only by the loss of breadth of interests, a decrease in mental activity, the emergence of a purely rational attitude towards close people with the need for their care, and some isolation in the family circle.

Thus, the fourth stage is the formation of stable remission. Two main types of the latter can be distinguished. The first is characterized by the fact that mental infantilism (or juvenileism) in combination with schizothymic manifestations comes to the fore, the second is determined by pronounced schizoid personality traits with traits of autism and eccentricity.

Attack with symptoms of “metaphysical intoxication” is a condition that develops in adolescence, characterized by the dominance in the mental life of the subject of affectively charged one-sided intellectual activity (usually abstract content) and leading to various forms of social and labor maladjustment.

The actual “metaphysical” content of the ideational activity of patients, which determined the name of the syndrome, is not mandatory. The manifestations of this phenomenon are significantly diverse. Some patients really devote themselves to the search for metaphysical or philosophical “truths,” while others are obsessed with ideas of spiritual or physical self-improvement, which they elevate to the rank of a worldview; still others spend a lot of time and energy on the invention of a “perpetual” or “supportless” engine, solving currently unsolvable mathematical or physical problems; still others turn to Christianity, Buddhism, and Hinduism, becoming religious fanatics and members of various sects.

Qualifying the state of “metaphysical intoxication” as a purely age-related (youthful) symptom complex, L. B. Dubnitsky (1977) identified 2 obligatory psychopathological signs in its structure: the presence of an extremely valuable education, which determines the pronounced affective charge of patients in accordance with their views or ideas and their dominant significance in the entire mental life of an individual; one-sided increased attraction to cognitive activity - so-called spiritual attractions. Depending on the predominance of the first or second sign, different clinical variants of the type of attack under consideration are distinguished.

The affective version of “metaphysical intoxication” is more common, i.e., with a predominance of the first sign - overvalued formations of an affective nature. In these cases, the most intense affective saturation of the state predominates, the actual ideational developments take a secondary place, and the interpretative side of the patients’ intellectual activity is reduced to a minimum. Patients usually borrow generally popular ideas or other people's views, but defend them with an indestructible affective charge. There is a dominant feeling of conviction in the special significance and correctness of one’s own activities. The content of these ideas most often includes religious views, parapsychology, and the occult. Evidence of the predominance of affect over idea is a shade of ecstasy in the state: patients declare a mystical insight into the essence of the issues of existence, knowledge of the meaning of life during the period of “inspiration,” “insight,” etc. The formation of such a “worldview” usually occurs quickly according to the “ crystallization,” and its content is often in direct contradiction with the patients’ past life experiences, their previous interests, and personal attitudes. The presence of phase affective disorders gives these conditions a special coloring. With depressive affect, patients who have been involved in issues of philosophy or religion come to idealism, metaphysics, mysticism or accept the views of “nihilists”, “superfluous people”, “beatniks”. However, even after depression has passed, the interests of patients, as well as their activities, are determined by a selective range of issues that dominate the consciousness to the detriment of real interests and activities. During periods of exacerbation of the condition, the “obsession” of patients reaches the level of so-called overvalued delirium [Smulevich A. B., 1972; Birnbaum K., 1915]. At the same time, numerous (albeit episodic) subpsychotic symptoms are noted. Characteristic is a distortion of the sleep-wakefulness rhythm, sometimes persistent insomnia, short-term oneiric disorders, individual hypnagogic hallucinations and hallucinations of the imagination, corresponding to the content of “metaphysical intoxication.” Less common are acute transient disturbances in thinking, interpreted by patients from the standpoint of their own “worldview.”

The active stage of the disease with the dominance of the phenomena of “metaphysical intoxication”, as well as in heboid conditions, is limited to the period of adolescence, beyond which there occurs a pronounced reduction of all positive disorders, smoothing and compensation of personal changes, good, steadily increasing social and labor growth, i.e. e. a state of stable remission such as practical recovery [Bilzho A. G., 1987].

With this type of attack, there is also a phasic pattern in the development of clinical manifestations, coinciding with the stages of the pubertal period.

The disease develops more often in men. The initial period of the disease refers to adolescence (12-14 years). The adolescence phase is marked by the intensification of highly valuable activities of various contents: computer classes (with an emphasis on game programs and virtual communication via the Internet), poetry, sports, chemical experiments, photography, music, etc. Such hobbies are usually short-lived, patients quickly “cool down” and “switch” to new activities. A significant place in the mechanism of overvalued activity belongs to fantasy. The content of overvalued activity is directly dependent on affect. This is especially evident in cases of depression accompanied by “philosophical quests.” When depression disappears, patients experience a “painful anticipation of happiness.” Simultaneously with the emergence of various forms of overvalued activity, the isolation of patients from others increases, which they experience as an “inferiority complex.”

At the stage of the active course of the disease (15-16 years), all patients show dominance of unilateral activity and a pronounced affective intensity of the state. Becoming adherents of the philosophy of existentialism, the views of Kant or Nietzsche, accepting the ideas of Christianity or Buddhism, engaging in physical exercises or Einstein’s theory of relativity, patients do not for a minute doubt the truth and extreme significance of the views they defend, and indulge in their favorite activities with extraordinary tenacity and passion. “Immersed” in new interests, patients begin to skip classes at school, shirk household errands, sharply limit contacts, and show indifference to loved ones.

Typical for these cases is a distortion of the sleep-wake cycle: patients, studying in the evenings and staying up with books past midnight, have difficulty getting out of bed in the morning, experiencing a feeling of weakness and lethargy. The emergence of a religious or philosophical “worldview” is usually preceded by a characteristic change in mood: “transferring” their mood to the surrounding world, nature, art, patients seem to be constantly in a state of anticipation of extraordinary events, the upcoming “release” of new ideas of philosophical or religious content or inventions . These new ideas are perceived as “insight,” the knowledge of a new meaning in life with a “reassessment of values.” A philosophical worldview can take on the character of “overvalued delusional ideas.” The affective intensity of their ideas always gives the impression of fanaticism.

The described states are accompanied by various, albeit isolated, sensory phenomena. Sleep disturbances develop (often persistent insomnia), episodic hypnagogic hallucinations, isolated short-term oneiric disorders (often in a drowsy state), reflex hallucinations, and hallucinations of the imagination appear. Hypnagogic hallucinations that arise autochthonously or reactively throughout the entire phase of adolescence are often interpreted by patients in ideological terms. Some patients experience acute transient thinking disorders that are particularly pretentious and have a mystical interpretation.

By the age of 17-22 years, all the patients’ activities and their entire lifestyle are determined by “metaphysical intoxication” and altered affect. By this age, phase affective disorders (often bipolar), combined with intellectual activity, become especially clear. Despite this activity, signs of social maladaptation of patients are found. They usually leave their studies in the first years of higher education or are expelled due to academic failure. The performance of patients in the subsequent period remains uneven in this sense. By the age of 20-21, their inability to adapt to life, dependence on parents, and age-inappropriate naivety of judgment become more and more evident; one-sidedness of intellectual development, as well as a decrease sexual desire and signs of physical infantilism.

The postpubertal period (22 years - 25 years) is accompanied in these patients by a gradual “fading away” of supervaluable activity while maintaining erased cyclothyme-like affective phases and the emergence of opportunities for social adaptation. Patients return to school and begin to work. At the same time, in comparison with the premorbid, certain personality changes can be detected here: autism, a tendency to adhere to established routines and ways of life, elements of reasoning, insufficient self-criticism, distinct signs of mental and sometimes physical juvenileism. The remaining extremely valuable education still influences the preference of interests and activities of patients, most often becoming the content of their professional activity.

As a rule, these patients are subsequently distinguished by a relatively high level of professional productivity.

Attack with dysmorphophobic and psychasthenic-like disorders characterized primarily by a condition that in the literature since the time of E. Morselli (1886) has been defined by the concept of body dysmorphophobia - a painful disorder dominated by the idea of ​​an imaginary physical defect (form or function). Dysmorphophobia, as indicated by many researchers on the basis of epidemiological data, is a symptom complex that occurs mainly in adolescence and adolescence and represents one of the aspects of the manifestations of pubertal crises [Nadzharov R. A., Sternberg E. Ya., 1975; Shmaonova L. M., Liberman Yu. And Vrono M. Sh., 1980].

P. V. Morozov (1977) and D. A. Pozharitskaya (1993) found that this age includes not only the predominant frequency of these pictures, but also their certain age-related features, in particular their close combination with the so-called youthful psychasthenic-like symptom complex [Panteleeva G.P., 1965]. By disorders of the psychasthenic type we mean manifestations that resemble the personality characteristics characteristic of psychasthenic psychopaths. Here, in the clinical picture, the most common symptoms are the appearance of previously unusual indecision and uncertainty in one’s actions and actions, difficulties in dealing with feelings of constraint and tension in public, heightened reflection, a feeling of change in one’s personality and detachment from the real (“loss of the sense of the real” ), leading to disruption of adaptation to environmental living conditions. When this variant of an atypical pubertal attack manifests itself, dysmorphophobia prevails in some cases, and psychasthenic-like disorders prevail in others.

The described phenomena of dysmorphophobia and psychasthenic-like disorders are usually preceded by the emergence or intensification of schizoid features at the age of 11-13 years. Sometimes erased productive disorders are simultaneously observed: phobias, unstable sensitive ideas of relationships, subclinical bipolar affective phases. Later (12-14 years), ideas about a physical disability usually arise, which at first are practically no different from the teenager’s usual over-valued interest and concern about his own appearance. Fearing ridicule, teenagers disguise their imaginary physical disabilities with clothes or shoes and are embarrassed to undress in public. Some of them do intense physical exercise, others only follow a certain diet “in order to correct physical deficiencies.”

The manifest stage of the disease develops at the age of 15-18 years. Its onset is determined by the complication of the topic of dysmorphophobia: along with concerns about excess body weight, the presence of juvenile acne, patients begin to worry about the shape of the nose, impending baldness, subtle birthmarks, etc. The behavior of patients also changes sharply: they are completely overwhelmed by thoughts about the acne they have. “defects”, they leave school, quit work, do not go out, hide from friends and guests. While self-medicating, they constantly monitor their appearance with the help of a mirror - the “mirror” symptom. Patients persistently turn to cosmetologists and are ready to do anything to correct the defect. They often give pronounced affective reactions with hysterical features. In some cases, when patients develop definite depressive disorders, overvalued ideas of a physical disability acquire a polythematic character, approaching depressive delusions of self-blame; in others, dysmorphophobia remains monothematic: depressive affect is determined with great difficulty, and overvalued ideas of a physical disability develop into an uncorrectable system of beliefs, approaching delusions of a paranoid type. These patients often exhibit ideas of attitude, verbal illusions, and they declare that their ugliness is “openly” mocked everywhere. During this period, patients are usually hospitalized several times.

In cases with the presence of psychasthenic disorders, dysmorphophobic and hypochondriacal ideas of polymorphic content, sensitive ideas of attitude, and reflection like “moral hypochondria” are added to difficulties in contacts, tension and stiffness in public, fear of blushing, and doubts about the correctness of one’s actions. Affective disorders throughout this stage are bipolar, continuous in nature. There are also undulations in the severity of psychasthenic-like disorders, fluctuations in the level of dysmorphophobic and hypochondriacal ideas and sensitive ideas of attitude from the overvalued to the delusional register (bypassing the obsessive level), correlating with changes in the poles of affect and the severity of affective disorders. In states of depression, in addition to the actualization of dysmorphophobic ideas, subjectively more severe depersonalization-derealization disorders, phenomena of somatopsychic depersonalization, and episodes of acute depersonalization are noted. Despite the severity of clinical symptoms and the rapid onset of social and labor disadaptation, the level of negative changes is shallow. The condition of patients remains stable for a long time according to the same manifestations within adolescence.

By the age of 22-23 (for some a little earlier, for others later), a reduction in the ideas of physical disability gradually occurs, and psychasthenic-like disorders lose the character of a single symptom complex. They are fragmented into individual symptoms that do not have an affective component. Their relevance for patients is gradually lost.

By the age of 25, patients retain only erased affective disorders in the form of autochthonous subdepressive phases and short-term subdepressive reactions, in the clinical picture of which, however, some psychasthenic-like features appear (the predominance of anxious fears, fear of failure, causing trouble for others) or somewhat exaggerated taking care of your appearance. Sometimes there remain traits of isolation, isolation, superficiality, immaturity of judgments and interests, increased suggestibility; egocentrism and insufficient emotional attachment to loved ones are combined with a subordinate position in the family. Some patients are irritable and easily give affective reactions on minor occasions, subsequently citing increased fatigue and lack of restraint. Moreover, they allow themselves such reactions only at home.

After the described manifestations have passed, all patients work and cope with their studies quite well. They reach, as a rule, a relatively high professional level, although in some cases there is low initiative and productivity.

Sluggish schizophrenia in psychiatry is called a low-progressive form. Symptoms of low-grade schizophrenia are distinguished by a relatively shallow disorder of brain activity. The patient has vegetative neurotic disorders, phobias, hypochondria. Some patients have erased paranoid disorders. The clinical picture is slowly increasing, so in medical literature The disease is called mild schizophrenia without character changes.

Stages of development of low-grade schizophrenia

Most often, sluggish disease is not diagnosed due to blurred signs. The disease debuts in young people after twenty years of age. The development of pathology can be determined by the main periods:

1. A latent period during which there are no obvious signs.
2. Active (full development of the disease). It occurs continuously and manifests itself in a series of attacks.
3. Stage of stabilization with personal changes.

Main clinical signs diseases are:

• long hidden stage;
• gradual change in symptoms;
• circular flow with characteristic symptoms: obsession, disorder of self-awareness, overvalued ideas.

IN latent stage the patient does not show characteristic features. Career growth is possible in the professional field. Some behavioral disorders are not regarded by the patient himself or his relatives as a mental illness. Therefore in this period pathology is very rarely diagnosed. Some symptoms and signs of indolent disease are never recognized, and mental illness makes itself felt only in old age.

During the active period of the disease, attacks of inappropriate behavior appear. Patients may experience negative personality changes and delusional ideas. Outbreaks are usually associated with age-related changes. After an attack, stable remission is possible.

Characteristic signs of low-grade schizophrenia

During the latent (latent) period of the disease, people may experience the following symptoms:

• difficulties in contact with others;
• autism;
• selfishness;
• hysteria;
• anxiety;
• one-sidedness of interests;
• suspicion.

Signs of sluggish schizophrenia in women sometimes manifest themselves in hysterical-type reactions, which are followed by periods of causeless pessimism, tearfulness, and irritability. In women, exacerbation occurs before menstruation (premenstrual exacerbation). During such periods, patients note severe attacks self-doubt, sentimentality, anxiety and fear. Typically, women regard this condition as overwork and do not associate it with mental illness.

Sometimes people develop uncontrollable activity and overvalued beliefs. In such cases, relatives pay attention to some oddities in the behavior of the sick person:

• inexplicable optimism;
• increased excitability;
• performing ritual actions;
• nervous tics;
• sudden changes in mood: the appearance of fears, insomnia, fussiness.

In some cases, the only sign of sluggish schizophrenia in men may be a special reaction to external stimuli. Among these are depressive, hysterical, hypochondriacal or delusional. A similar reaction occurs, for example, when a highly valuable idea or object is lost.

But inadequate reactions cannot be ruled out as a result of the loss of a relative who was indifferent to the patient during his lifetime. During such periods, the patient develops persistent long-term depression, low mood, melancholy, and thoughts about the meaninglessness of life. As a person deepens into a depressive state, he becomes prone to self-blame for the death of a relative and obsessive memories. At the same time, hallucinations of the imagination appear.

The hypochondriacal reaction to a traumatic event involves suspicion. Patients believe that others are gloating about his grief or failure and catch mocking glances.

In the active phase of the disease, prolonged attacks occur, which are accompanied by depression with impaired thinking. In old age, the clinical picture is combined with anxiety, hysterics, delusions of jealousy, and litigiousness.

Depending on the obsessive disorders with sluggish schizophrenia, the following types are distinguished:

• with symptoms of obsession;
• with phenomena of depersonalization;
• hypochondriacal;
• with hysterical attacks;
• low-symptomatic.

Schizophrenia with obsessional symptoms

The clinical picture of the disease with symptoms of obsession is more often observed in anxious patients with a suspicious character. The harbingers of the disease are fears and persistent obsessions. For example, fear of heights, darkness, magic, people and other phobias. In the active period of the disease, phobias and obsessions play a leading role in diagnosis. Typically, this condition is long-term and characterized by incomplete remissions. The attacks occur against the background of a depressive disorder.

Sluggish neurosis-like schizophrenia, along with phobias, is complemented by anxiety. Sometimes patients experience attacks that resemble temporary insanity. Unlike ordinary neurosis, sluggish schizophrenia is accompanied by constant doubts of the patient about the correctness of already committed actions, ambivalence towards something (for example, love and hate at the same time). An attack can last from several months to several years. Patients may exhibit the following symptoms:

• obsessive urges;
• lack of motivation;
• contrasting thoughts;
• fear of going crazy;
• fear of injuring others or yourself;
• fear of contracting deadly diseases.

Obsessive-compulsive disorder gradually increases over several years. Over time, phobias become less understandable and become absurd. At the same time, patients do not have the desire to fight them. The violations are accompanied by various rituals, a feeling of helplessness and the need for support from loved ones.

Schizophrenia with symptoms of depersonalization

A variant of sluggish schizophrenia, in which disturbances of self-awareness predominate. The disease occurs continuously or with attacks. The disorder usually begins during adolescence. More often this type of disease is observed in men. Characteristic features:

• isolation;
• shyness;
• tendency to reflect;
• impressionability;
• coldness towards other people;
• dissatisfaction with oneself;
• somatic disorders: pain in the bridge of the nose and the back of the head, changes in gait.

During the progression of the disease, patients find their own actions unnatural. People often complain of an altered state. They believe that the former flexibility of the mind and imagination have disappeared. However, along with this, there appears a feeling of isolation from others, insensitivity. The patients themselves complain that they have lost empathy, have lost the ability to feel satisfaction or dissatisfaction, and the world has become uninteresting and gray.

Patients cannot remember what they were like before and cease to be aware of their activities and actions. Everything is perceived as meaningless and alien, mechanical. Sometimes they do not understand gestures and speech addressed to them, they experience dependence on the people around them, they cease to perceive themselves as an individual, and they see the world through someone else’s eyes. Essentially, patients play certain roles.

After the age of twenty, during the period of stabilization of the disease, people feel an incompleteness of feelings. They are not captured by emotions, and there are no attachments to others. All relationships are created exclusively on a rational basis. It is difficult for a person to build relationships with people and get along in a new team.

After acute manifestations during the period of remission, patients become selfish, cold, completely immersed in their own mental condition. They ignore the needs of relatives and loved ones.

Sluggish schizophrenia with symptoms of hypochondria

This variant of schizophrenia manifests itself in patients prone to hysteria. Already from childhood, suspiciousness and uncertainty are noted in such people. Children often catch colds, they are sensitive to weather changes, suffer from migraines, indigestion, dizziness, and allergies. The clinical picture is blurred, since somatic diseases come to the fore.

As patients get older, they complain about their health, bad feeling, heavy incurable diseases, although upon examination no signs of pathology are found in them. Vegetative disorders often occur:

• sweating;
• dyspnea;
• heart rhythm disturbance;
• chills;
• slight increase in temperature;
• nausea;
• sleep disorder

Against the background of autonomic disorders, sensory disturbances appear, movement disorders, bulimia, pain in various organs. Patients are constantly under medical supervision, but schizophrenia is not always suspected. Characteristic mental symptoms diseases are:

• senesthesia - peculiar motor disturbances (for example, emptiness in the body or unexplained heaviness);
• tearfulness;
• pessimism;
• irritability.

As the disease progresses, patients experience increased asthenia, a feeling of fatigue, and uncertainty. Acute period manifested by fear of death. The person does not understand what is happening to him, calls an ambulance, and requires immediate examination and treatment. Theatricality prevails in the behavior of such people, with which they try to attract attention to themselves. There is often a persistent attachment to drug therapy.

Sluggish schizophrenia with manifestations of hysteria

As a rule, patients with this form of the disease are unbalanced and impulsive. The whims and hysterics that begin to appear in childhood come to the fore. Often patients are artistically gifted people. Hysteria in a child is often combined with such somatic manifestations as hyperkinesis, involuntary urination at night (enuresis).

The disease begins to have a noticeable effect by the age of 10 years. The child develops complexes, suspiciousness, demonstrative behavior, and expressiveness. Children wishful thinking and fantasize. They can deify someone with a hint of sexual desire (regardless of the patient’s age).

With age, such people become domestic tyrants, show intemperance, create violent scenes until they lose consciousness. Minor stress results for them in a seething manifestation of emotions, dizziness, a feeling of lightheadedness, and impaired speech and writing.

During the period of exacerbation, the patient is prone to vagrancy, gambling, drug addiction and alcoholism. Sometimes patients experience pseudohallucinations, a craving for magical thinking, fatalism, a tendency to destruction, and the same type of behavior. The patient believes in his mission and divine influence on other people. Manifestations such as affectation, excessive frankness, and mannerisms are noteworthy. IN old age patients are more like eccentrics or slovenly extravagant ladies. Such people tend to emphasize their belonging to a “select community.”

Sluggish low-symptomatic schizophrenia

Signs of the disease often appear vigorously after 20 years of life. Patients experience the following symptoms:

• decreased mental activity;
• lack of initiative;
• obsessive-compulsive disorders;
• monosyllabic speech;
• emotional poverty;
• asthenia.

Despite such deviations, patients have professional skills until old age and can work. Outwardly, people are calm and do not show aggression towards others or themselves. It is difficult to diagnose the disease in this variant, therefore treatment of low-symptomatic, sluggish schizophrenia is practically not carried out.