Febrile schizophrenia is one of the most complex types of mental disorder, manifested by clouding of consciousness, catatonic symptoms, vegetative dysfunction, feverish syndrome. In psychiatry, it is also known as lethal catatonia, hypertoxic catatonia (schizophrenia), lethal catatonia. According to psychiatrists, the listed names of the disorder create an erroneous idea of the disease, without revealing its essence. Attacks of lethal catatonia are rare and characteristic of recurrent schizophrenia. Sometimes occur when the coat-like variant. Mortality is noted in 20-25% of cases. To prevent the death of the patient, timely hospitalization and the appointment of adequate therapy are necessary.
Since the disorder is an attack of oneiric catatonia, in which the carrier of the disorder freezes in a certain position, plunging into its fantastic visions. Oneiroid seizures characteristic of periodic or paroxysmal flow of schizophrenia. After each exacerbation of personal changes become more pronounced.
As with all types of schizophrenia, the cause of the development of the febrile form is the presence of a pathogenic gene that is inherited. However, the risk of developing fatal catatonia is increased by a number of the following factors:
- intense, strong psychosocial stress;
- drug use in particular cannabis – a substance made from Indian hemp;
- low socio-economic level.
Hypertoxic schizophrenia is different from other forms of schizophrenia. It has a peculiar symptomatology, which gave rise to contradictory terminology in the name of the disorder. First of all, she has no symptoms of paranoid schizophrenia. The main symptom of febrile schizophrenia is considered to be an increase in body temperature to 38–40 ° C. This temperature persists for a long time and is not removed by taking antipyretic drugs. Treatment with antibiotics, which are drunk because of the suspicion of an inflammatory process, has no effect.
Rashes appear on the skin from the usual redness or rash to bruising and suppuration. Such manifestations are explained by an increase in the fragility of the vessel walls. In addition, the disease is characterized by the presence of catatonic manifestations:
- involuntary fantasizing about space travel, global catastrophes,
- incoherence, meaninglessness of speech,
- stereotypical movements,
- bouts of fever.
The outcome of an attack can have two options:
- swelling of the brain, followed by death,
- full recovery.
Features of febrile schizophrenia depending on its course
Febrile attacks with periodic disorder are most common in women. The first signs of illness arise in the period of early adolescence or at a young age. If there is a series of attacks, then each subsequent proceeds in a milder form than the previous one.
In that case, if there is a paroxysmal course of the disorder, then febrile seizures will occur in the future. The external state of the carrier of the disorder against the background of an increase in temperature can either be well or be very disturbed with a slight rise in temperature. This situation is not possible to establish the relationship between the rise in temperature and the severity of the patient’s condition. However, in any case, if the temperature drops to normal values, the exacerbation of the disorder disappears.
Febrile schizophrenia, accompanied by signs of Oneiroid syndrome begins with catatonic manifestations and fever. The patient has hallucinations, the contents of which are filled with fantasies about the cosmos, global catastrophes, travels.
At the very beginning of the psychosis, the patient understands where he is, but after some time he becomes clouded, and he becomes detached from reality, plunges into painful experiences. Perhaps the onset of catatonic stupor with all its manifestations:
- refusal to eat
- “Freezing” in an uncomfortable position for a long time,
- spontaneous defecation and urination.
The stupor can alternate with excitement, during which the patient has seen senseless, stereotyped movements, echolalia , ecopraxia , the desire to destroy things around him. Also at the time of the attack, the following symptoms appear:
- skin redness and rash,
- feverish eyes,
- weathered lips,
- furred or red dry tongue.
Despite a significant increase in temperature, the patient is not diagnosed with infectious diseases or somatic diseases. A feature of the disorder is the fact that the temperature rises in the morning and decreases in the evening. Feverish condition can persist from several days to several weeks. To save the patient not only from relapse disorder, the development of a personal defect, but also from death can only timely treatment.
In some cases, the state of catatonic excitation can be replaced by amential excitation. Its feature is the inability of the patient to capture the connection between objects, to perceive the events as a whole. At the time of the attack, the person sees separate fragments of what is happening, but is not able to combine them into a single whole.
A person in a state of amential arousal, despite being in bed, behaves restlessly: turning his head, waving his arms, knocking his legs. Speech at the time of the attack is incoherent, filled with a set of incoherent words. At the end of the attack, the patient cannot remember the period of amentia (that was at the time of the attack).
Amential excitation may be accompanied by the appearance of trophic disorders in the form of blisters on the body in the folds of the elbows, heels, sacral region and a sharp rise in temperature to 39-40 ° C. The fever lasts no more than two weeks. In some cases, the person begins to sort out clothes or a sheet with small movements of his hands. Such manifestations indicate the occurrence of a life-threatening outcome of the disease.
Sometimes insane arousal changes with hyperkinetic arousal. It is characterized by random, irregular, involuntary movements in different groups of muscles of the legs and arms. Such a state can be interrupted by episodes of amental or catatonic excitation. Accompanied by hyperkinetic arousal fever of the wrong type, persisting for 1-2 weeks. The state in this period is heavy.
Treatment of hypertoxic schizophrenia is possible only in stationary conditions. The main drugs used in the treatment of disease, are antipsychotics. Their use in this pathology allowed us to abandon the term “fatal schizophrenia”, which was previously called febrile schizophrenia. Treatment involves a rapid increase in the dose of the drug from an average to the maximum allowable.
The course of therapy lasts on average from two to four months. Treatment should be continuous, as interruptions can cause the patient to deteriorate. In some cases, a special approach to the selection of antipsychotics is required. The need to choose another vector of therapy is indicated by such signs as:
- drop in muscle tone
- maintaining high body temperature.
Usually in such cases, treatment with drugs is replaced by electroconvulsive therapy in an intensive mode. Electroconvulsive therapy is conducted with varying frequency of sessions: the total number ranges from 3 to 12. In the period of acute electroshock treatment is carried out on a daily basis, after the normalization of temperature and improve the mental state of electroconvulsive therapy sessions are held every other day. In some cases, electroconvulsive therapy combined with the use of antipsychotics.
In addition to these methods, treatment involves the use of vitamins. C , group B, kordiamina, antihistamine, hormonal drugs. To prevent the development of cerebral edema, diuretics are prescribed to patients. When patients are exhausted, therapy is supplemented by the introduction of intravenous injections (hypertonic sodium chloride solution).
At home, treatment is unacceptable and can be fatal. In some cases, it is necessary to carry out emergency medical measures aimed at correcting metabolic disorders, restoring the functions of the kidneys and liver, normalizing the activity of the cardiovascular system, and preventing brain edema.