Schizophrenia is a fairly common mental illness. It is manifested by violations of thinking, perception, emotional-volitional disorders and inappropriate behavior. The term “schizophrenia” was proposed by the Swiss psychopathologist E. Bleiler . Literally, it means “splitting of the mind” (from the ancient Greek words “ σχίζω ” – I split and “ φρήν ” – reason, mind).
Historical background on schizophrenia
The first information about schizophrenia-like symptoms dates back to 2000 BC. Periodically, many eminent physicians of various eras have also described similar psychotic disorders. In his work The Medical Canon, Avicenna spoke of severe insanity, somewhat reminiscent of schizophrenia. Pathology began to be studied in more detail only at the end of the 19th century. The German psychiatrist E. Kraepelin (1856-1926) observed adolescent patients suffering from various psychoses. In the process of research, he found that after some time all patients developed a similar state of special dementia. It has been called “dementia praecox” ( dementia praecox ). Other psychiatrists have added to and expanded on the symptoms, course, and outcomes of this illness. At the beginning of the 20th century, the Swiss psychopathologist E. Bleiler proposed introducing a new name for the disease – “schizophrenia”. He proved that pathology occurs not only at a young age, but also in adulthood. Its characteristic feature is not dementia, but “violation of the unity” of the psyche. The proposed concept of schizophrenia was recognized by all psychiatrists.
Why does schizophrenia develop?
Despite the high level of development of modern medicine, it has not yet been possible to establish the exact cause of this disease. Psychiatrists are more inclined to the genetic theory of the occurrence of schizophrenia. It says: if there is a patient with schizophrenia in the family, then his blood relatives are at high risk of developing this pathology. However, the type of inheritance and the molecular genetic basis of the disease are unknown. An important role in the development of schizophrenia is played by personality traits, low social status (poverty, poor living conditions, a dysfunctional family, etc.), various diseases (drug addiction, alcoholism, chronic somatic pathologies, traumatic brain injuries, protracted psychotraumatic situations, etc.) Sometimes The onset of schizophrenia is preceded by stressful events, but most patients develop schizophrenia “spontaneously”.
Typical forms of the disease
Typical forms of schizophrenia include paranoid, hebephrenic, catatonic and simple forms.
Paranoid form (F20.0)
Most often in their practice, psychiatrists encounter a paranoid form of schizophrenia. In addition to the main signs of schizophrenia (impaired coherence of thinking, autism, decreased emotions and their inadequacy), delusions predominate in the clinical picture of this form. It typically manifests as persecutory delusions without hallucinations, grandeur delusions, or influence delusions. There may be signs of mental automatism, when patients believe that someone from the outside influences their own thoughts and actions.
Hebephrenic form (F20.1)
The most malignant form of schizophrenia is hebephrenic. This form is characterized by manifestations of childishness and foolish, ridiculous excitement. Patients make faces, can laugh for no reason, and then suddenly become indignant, show aggression and destroy everything in their path. Their speech is inconsistent, saturated with repetitions and invented words, very often accompanied by cynical abuse. The disease usually begins in adolescence (12-15 years) and progresses rapidly.
Catatonic form (F20.2)
In the clinical picture of the catatonic form of schizophrenia, motor function disorders predominate. Patients for a long period of time are in an unnatural and often uncomfortable position, without feeling tired. They refuse to follow instructions, do not answer questions, although they understand the words and commands of the interlocutor. Immobility in some cases (catalepsy, a symptom of “mental (air) cushion”) is replaced by attacks of catatonic excitement and impulsive actions. In addition, patients can copy facial expressions, movements and statements of the interlocutor.
Simple form (F20.6)
For a simple form of schizophrenia, an increase in exclusively negative symptoms, in particular, apathico-abulic syndrome, is characteristic. It is manifested by emotional poverty, indifference to the world around, indifference to oneself, lack of initiative, inactivity and rapidly growing isolation from people around. At first, a person refuses to study or work, breaks off relations with relatives and friends, wanders. Then, gradually, the accumulated baggage of knowledge is lost and “schizophrenic dementia” develops.
Atypical forms of the disease
In the clinic of atypical forms of schizophrenia, non-standard, not quite characteristic signs predominate. Atypical forms include schizoaffective psychosis, schizotypal disorder ( neurosis-like and variant), febrile schizophrenia, and some other forms of schizophrenia.
Schizoaffective psychosis (F 25)
Schizoaffective psychosis is a special condition that is characterized by the paroxysmal occurrence of schizophrenic (delusional, hallucinatory) and affective symptoms (manic, depressive and mixed). These symptoms develop during the same attack. At the same time, the clinical picture of the attack does not meet either the criteria for manic-depressive psychosis or the criteria for schizophrenia.
Schizotypal disorder ( neurosis-like variant) (F 21)
The neurosis -like variant of schizotypal disorder is manifested by asthenic, hysterical symptoms or obsessive phenomena that resemble the clinic of the corresponding neuroses. However, neurosis is a psychogenic reaction to a traumatic situation. A schizotypal disorder is a disease that occurs spontaneously and does not correspond to the existing frustrating experiences. In other words, it is not a response to a stressful situation and is characterized by absurdity, deliberateness, as well as isolation from reality.
In extremely rare cases, there are acute psychotic states with signs of severe toxicosis, called febrile schizophrenia. Patients have a high temperature, symptoms of somatic disorders (subcutaneous and intraorganic hemorrhages, dehydration, tachycardia, etc.) are increasing . Patients are confused, rush about in bed, make senseless movements, cannot say who they are and where they are. Febrile schizophrenia should be distinguished from neuroleptic malignant syndrome. This is a fairly rare life-threatening disorder associated with the use of psychotropic drugs, most often neuroleptics. Malignant neuroleptic syndrome is manifested, as a rule, by muscle rigidity, fever, vegetative changes and various mental disorders.
Rare forms of delusional psychosis
Rare forms of delusional psychoses include chronic delusional disorders (paranoia, late paraphrenia , etc.), acute transient psychoses.
Chronic delusional disorders (F22)
This group of psychoses includes various disorders in which chronic delusions are the only or most prominent clinical feature. Delusional disorders observed in patients cannot be classified as schizophrenic, organic or affective. It is likely that the causes of their occurrence are genetic predisposition, personality traits, life circumstances and other factors. Chronic delusional disorders include paranoia, tardive paraphrenia , paranoid psychosis, and paranoid schizophrenia with sensitive relationship delusions.
Patients suffering from paranoia are often suspicious, touchy, jealous. They tend to see the intrigues of ill-wishers in random events, remember grievances for a long time, do not perceive criticism, and treat people around them with acute distrust. They often have overvalued delusions of grandeur and/or persecution, on the basis of which patients are able to build complex logical conspiracy theories directed against themselves. Often, those suffering from paranoia write a huge number of complaints against imaginary ill-wishers to various authorities, and also start lawsuits.
Acute transient psychoses (F23)
The clinic of acute transient psychosis develops after a fleeting period of confusion, anxiety, restlessness and insomnia. Psychosis is characterized by the appearance of acute sensory delusions with rapid changes in its structure. Most often, there are delusions of influence, persecution, relationships, staging, false recognitions and delusions of a double. Hallucinatory experiences, true auditory and pseudohallucinations are possible. As a rule, they are unstable and tend to quickly change each other.
Types of schizophrenia and prognosis
There are three types of the course of schizophrenia: continuous, periodic ( recurrent ) and paroxysmal- progressive (coat-like).
This type of schizophrenia is characterized by steadily progressive dynamics. Depending on the degree of its progression , a malignant, moderately progressive and sluggish course is distinguished. With a continuous course, there are periods of exacerbation of the symptoms of schizophrenia and their relief. However, full-fledged qualitative remissions are not observed. The clinical and social prognosis in the majority of such patients is unfavorable. The vast majority of patients undergo inpatient treatment or stay in neuropsychiatric boarding schools. All of them sooner or later receive the first group of disability. In some patients, after many years from the onset of the disease, clinical manifestations are somewhat reduced and due to this they are kept at home, remaining unable to work.
Periodic ( recurrent ) schizophrenia
With this type of schizophrenia, attacks of productive mental disorders occur periodically and are not accompanied by profound personality changes. Their number is different. Some have one attack in their entire life, others have several, and still others have more than ten. Attacks of schizophrenia can last from a few days to several months. They are of the same type (similar to each other) or heterogeneous (dissimilar to each other). The medical and social prognosis for intermittent schizophrenia is generally quite favorable. This is due to the insignificant severity of negative personality changes or their absence due to persistent intermission or practical recovery. The prognosis worsens with worsening, lengthening and more frequent attacks of recurrent schizophrenia.
Paroxysmal progressive schizophrenia
The most common paroxysmal -progressive course of schizophrenia. This variant of the course is characterized by the presence of episodic attacks of schizophrenia with inferior low-quality remissions. Each attack leads to a personality defect, as well as an increase in delusions and hallucinations. The degree of progression of fur-like schizophrenia and the depth of the mental defect may vary. The clinical and social prognosis of this type of schizophrenia course is determined by the rate of increase in personality changes, as well as the duration, frequency and severity of attacks. An unfavorable prognosis has a fur-like schizophrenia with a rapidly emerging mental defect. Relatively favorable prognosis for sluggish coat-like schizophrenia. It is characterized by the rare occurrence of seizures that are non -psychotic in nature. The rest of the cases are at intermediate levels between these extreme options.
Differential diagnosis of schizophrenia
The diagnosis of schizophrenia is established after the duration of the disease has exceeded six months. In this case, there must be a significant violation of social adaptation or disability. At its core, schizophrenia is a diagnosis of exclusion. To establish it, it is necessary to exclude affective disorders, alcoholism and drug addiction, which could lead to the development of psychopathological symptoms. Huge difficulties arise in the differential diagnosis of catatonic and paranoid forms of schizophrenia from the corresponding forms of somatogenic, infectious, toxic, traumatic and other exogenous psychoses during their long course. The basis for the construction of the diagnosis is specific clinical manifestations: emotional dullness, disturbances in the harmony of thinking and volitional disorders.
Suicidal behavior in patients with schizophrenia
The term “suicidal behavior” refers to a conscious action that is aimed at voluntarily depriving oneself of one’s life. In schizophrenia, one can speak about it only if the suicidal person is aware of his actions (does not stay in a psychotic state, and also does not have pronounced personality defects). In other cases, such behavior is considered auto-aggressive .
According to statistics, about half of patients with schizophrenia have attempted suicide over a twenty-year period of the disease. Of these, 10% were completed. Suicidal behavior is a direct indication for seeking psychiatric advice. And the best option is to hospitalize the suicide in a psychiatric hospital.
Treatment of schizophrenia
The vast majority of people with schizophrenia need qualified help in a psychiatric hospital. Hospitalization allows for constant monitoring of the patient, capturing minimal changes in his condition. At the same time, the clinical manifestations of the disease are detailed, additional studies are carried out, and psychological tests are performed.
Despite advances in modern medicine, there is no way to completely cure schizophrenia. However, the methods of therapy used today can significantly alleviate the patient’s condition, reduce the number of relapses of the disease and almost completely restore his social and daily functioning. Psychopharmacotherapy plays a major role in the treatment of schizophrenia . For this purpose, three groups of psychotropic drugs are used: antipsychotics, antidepressants and tranquilizers. They are used for a long time (from a week to several years, up to a life-long intake). It is important to remember that the sooner treatment for schizophrenia is started, the better the prognosis awaits the patient.
Treatment with psychotropic drugs
Antipsychotic therapy is indicated in the presence of an acute condition. The choice of drug depends on the clinical symptoms of an attack (exacerbation). In the case of dominance of psychomotor agitation, hostility, aggressiveness, neuroleptics are used, which have a predominant sedative effect ( tizercin , chlorpromazine , chlorprothixene ). If hallucinatory-paranoid symptoms predominate, “powerful” typical antipsychotics are prescribed that are able to fight them (haloperidol, trifluoperazine ). The polymorphism of clinical symptoms requires the use of typical antipsychotics with a broad antipsychotic effect ( mazheptil or piportil ). Sluggish schizophrenia is treated with low to moderate doses of antipsychotics and antidepressants. In the case of sluggish schizophrenia, accompanied by phobias and obsessions , sedative tranquilizers ( relanium , phenazepam, alprazolam, lorazepam ) are used.
Dealing with the side effects of antipsychotics
Prolonged use of antipsychotics very often leads to their drug intolerance. It manifests itself by side effects from the nervous system and the development of complications ( tardive dyskinesia and neurolepsy ). In such situations, antipsychotics are prescribed that do not cause or practically do not cause unwanted neurological symptoms ( leponex , ziprexa , rispolept ). In the event of dyskinesia , antiparkinsonian drugs ( akineton , napam , cyclodol, etc.) are included in the therapy . If depressive disorders appear, antidepressants are used ( reksetin , anafranil , lyudiomil , amitriptyline, etc.). You should know that all appointments are made and corrected by the doctor. Spontaneous withdrawal of drugs is prohibited. This carries a high risk of relapse.
Other treatments for schizophrenia
To date, electroconvulsive therapy (ECT), insulin coma and atropinocoma therapy remain relevant. They are not considered as first-line treatments, but they can be used when other methods are ineffective. Psychotherapy, family therapy, art therapy and other methods are aimed at social and professional rehabilitation.
Social rehabilitation is indicated for almost all patients suffering from schizophrenia, with the exception of patients in whom the ability to work is preserved and social adaptation has an appropriate level. Even in severe cases, a number of patients partially recover basic self-care skills. After a multi-stage social rehabilitation, they can be involved in simple labor activities.
Advice for the family of a person with schizophrenia
Schizophrenia is a serious illness, both for the person himself and for his close circle. However, if a person is not able to understand that he is sick, the family is simply obliged to recognize the disease and seek help from a psychiatrist. It is time to dispel the existing stereotypes that it is impossible to help a patient with schizophrenia. Maybe. With properly selected therapy, long-term high-quality remissions are achieved with full recovery of working capacity over a long period of time. The main thing is to recognize the disease in time and start treatment. If this is not done, the person, as a rule, is waiting for emergency hospitalization already in a state of psychosis. Don’t wait until the worst happens to take action. Relatives are the only people who can change the life of a schizophrenic patient for the better. The quality of life of patients suffering from this disease largely depends on their support and their participation in the recovery process. If you suspect that someone close to you has schizophrenia, contact a psychiatrist immediately.