There is no accurate data on the prevalence of paranoid personality disorder. Patients rarely ask for help themselves and, when talking to a doctor, deny manifestations of personality disorder if they are sent by their relatives. Among the relatives of patients with schizophrenia, more cases of disorder than in the population. In men, it is more common than in women; individuals at high risk are those who have been formed in situations of various kinds of communicative restrictions (members of national minorities, residents of states with a ollitarian regime, emigrants, deaf people).

Clinic. Paranoid personality disorder is characterized by constant suspicion and distrust of people in general, a tendency to shift responsibility from themselves to others. This is an easily recognizable from fiction collective image of a collector of petty offenses and injustices, hypocrites, jealous husband, litigies . AT all kinds of situations they feel used in the interests of others, betrayed or offended. They are full of prejudices and often ascribe to others those thoughts and promptings that refuse to recognize in themselves. Transit ideas of a relationship are common, the wrong premises of which are purposefully and logically justified. At the same time, patients are convinced of their own objectivity and rationality. Their affective repertoire is limited, they lack humor, spiritual warmth, they often seem to be unemotional. The manifestations of power and authority are highly valued, all that is weakly and impairedly causes their contempt.

1. Gannushkin considered the main feature of this type to be the tendency to form overvalued ideas, the most important of which “is the thought of the special meaning of … self.”In business, they can make an impression of energetic and active people, but others, as a rule, evoke negative feelings.

The conversation draws attention to muscular tension, inability to relax, and extreme suspicion of the doctor’s interpretations that may be unfavorable to them. Sometimes the disorder is a precursor to schizophrenia. In most cases, it lasts a lifetime, accompanied by problematic situations at work and in the patient’s family. As maturity is achieved and with low life stress, a psychological defense mechanism can act – the formation of reactions when patients become stressed by altruists.

In order to diagnose a paranoid personality disorder, a condition other than personality disorders (F60) must correspond to at least four of the following qualities or behavioral stereotypes: 1) excessive sensitivity to failures and failures; 2) constant dissatisfaction with other people, a tendency not to forgive insults, neglect, damage caused; 3) suspicion and a persistent tendency to distort the experience, when the neutral or friendly attitude of others is wrongly interpreted as hostile or dismissive; 4) laxity, selfishness, quarreliness and persistent, inadequate defense of one’s own rights;5) frequent unjustified suspicions of infidelity of marital or sexual partners; 6) increased self-esteem with a tendency to take what is happening to your account; 7) frequent unsubstantiated thoughts of conspiracies that subjectively explain events in a close or broad social environment.

Differential diagnosis. In the case of paranoid personality disorder, delineated delusional structures characteristic of delusional psychosis, as well as hallucinations and formal thinking disorders inherent in paranoid schizophrenia, are absent. Patients with a borderline type of emotionally unstable personality disorder are distinguished from this type by their ability to establish, albeit saturated with suspicion and heightened vulnerability, but extremely emotional relationships with others. Paranoid psychopaths are distinguished from antisocial lack of a chain of antisocial behavior in the anamnesis. With schizoid psychopaths, they are brought together by limited emotionality, but they are distinguished by their characteristic trait of intense suspicion and distrust. The most difficult to distinguish between paranoid and schizotypal disorder (F21), for which suspicion is also a feature.

In contrast to schizotypical , patients of this type do not have such a bizarre complex of behavioral, sensory and mental disorders, they are characterized not so much by the absence of distortions of communication skills, but by their characteristic orientation (eccentricity, eccentricity).

Treatment. The best approach is supportive individual psychotherapy. These patients do not tolerate group therapy, and behavioral seems to them too compulsory. Cognitive -behavioral programs aimed at reducing the background level of anxiety and improving the skills of problem-solving behavior achieve greater success . The physician should strive to be as open as possible, consistent and authentic, honest recognition of something here is always preferable to defensive reasoning. The doctor’s statements should be clear, unambiguous, the style of treatment should be professional, respectful and somewhat distant , given that trust and closeness of relationships are the problem areas of these patients.

One should not be overly zealous with the interpretation of dependency and the lowered self-esteem of patients, hiding behind the protective facade of mistrust and hostility. The basic setting of an unbiased and benevolent assistant helps the patient to adopt alternative explanations for what is happening. It is more productive not to rush into correcting such defense mechanisms as the negation of reality and the projection of guilt on others. It is better to just attentively listen to the accusations and complaints of the patient, avoiding standing on someone’s side.

These patients take drug therapy with an excessive amount of suspicion and the effect of it is usually not noted. Although the direct effect is indeed problematic, nonetheless, during episodes of alarming agitation, short-term administration of benzodiazepines is possible ; Delusionalinterpretations are an indication for prescribing small doses of Sonapax or Haloperidol .

Disorders of personality and behavior due to illness, damage or dysfunction of the brain

A common cause is a variety of structural brain damage, among which the most common trauma to the skull . The most etiologically significant are damage to the temporal and frontal areas.

Clinic. The syndrome is characterized by sharpening (strengthening) premorbid personality traits or the appearance of pathological personality traits. Control of impulses and expressions of emotions decreases, the latter become labile and superficial with a predominance of euphoria or apathy.Euphoria is devoid of true fun, which can be recognized by the patient. On the euphoric background, especially when the frontal lobes are damaged, there is a characteristic tendency to flat jokes.

The frontal syndrome as a whole is characterized by indifference, apathy, lack of involvement in what is happening in the immediate environment. There are frequent outbursts of rage on minor occasions, especially during alcoholism, accompanied by aggressive behavior. The generally accepted norms of behavior are not observed, sexual disinhibition and law conflicts are frequent. Typical is the inability of patients to anticipate the consequences of their actions, to understand the problems that they create to others. Blaming others is the most frequently used technique for solving their problems.

In cases of temporal epilepsy, there is often a loss of a sense of humor, viscosity (a tendency to pseudo-philosophizing , entrapped stuck on serious topics, ignoring the lack of interest in the interlocutor) and pronounced aggressiveness beyond convulsive manifestations. For such patients, characterized by a triad: the hypergraph (the endless diary writing, texts), increased religiosity (or preoccupation with a sublime idea) and hy about – or hypersexuality. Possible slight cognitive impairment (reduction of short-term memory) does not reach the degree of intellectual decline.

In the presence of structural morphological changes, the syndrome is persistent. The growth of an organic lesion (brain tumor, Huntington’s disease ) can transform the syndrome into dementia. In some cases, with the successful treatment of a primary disorder or cessation of intoxication, the syndrome may be reversed.

Diagnosis. The ICD-10 formulates the following diagnostic criteria common to the group of disorders F07: 1) objective data on the presence of organic cerebral disease, brain damage; 2) the absence of impaired consciousness or pronounced memory impairment; 3) the lack of convincing data on the presence of a different cause of personal and behavioral disorders characteristic of group F07.

Differential diagnosis. With dementia, personality disorders are only one aspect of global intellectual decline. The presence of an organic etiological factor distinguishes this syndrome from other mental illnesses accompanied by personality changes.

Treatment. The main is the impact (if possible) on the primary organic violation. Symptomatic treatment with various (depending on the target of therapy) drugs is variously effective: antipsychotics, anxiolytics , lithium, hormones, beta-blockers, non-tricyclic anti-depressant trazodone , anticonvulsants. In the presence of aggressive behavior in cases of temporal epilepsy, carbamazepine therapy is indicated . Should strive to avoid alcoholism. The participation of social workers contributes to the improvement of social accommodation of patients. Family counseling should provide emotional support for the patient’s family members and specific advice to help minimize unwanted patient behavior. Antisocial inclinations often make it necessary to keep these patients in specialized closed medical institutions.

Paranoid schizophrenia is the type of disease that occurs most often. Sometimes mistakenly called paranoid schizophrenia. Manifested by the presence of delusions of persecution, obsessive ideas, conversations with non-existent interlocutors, while there are problems with self-identification. Sometimes paranoid schizophrenia is accompanied by hallucinations and catatonic symptoms (mild).

The exact causes of the disease are still not fully determined. Possible causes that can cause hereditary mental disorders are: the influence of the environment, family education, prenatal and stressful factors, alcoholism, drug addiction and disorders in the brain (neurobiological factors), age crisis.

Prevention of paranoid schizophrenia

Schizophrenia affects about 1% of the population. The first, pronounced attack often comes to 30 years. But the early signs and symptoms of paranoid schizophrenia can occur as early as adolescence / adolescence. During his life, anyone can get schizophrenia (the probability of developing the disease is 1-2%). In the course of the development of the disease, the social aspects of life and the functioning of a person in society suffer, which causes a person to have a strong mental discomfort.

Diagnosis of paranoid schizophrenia

In the Center for Psychiatry and Psychotherapy “Transformation Clinic”, clients will receive comprehensive medical care:

• diagnostics and detection of mental disorders;
• determining the risk of schizophrenia;
• detection of symptoms of the disease;
• selection and appointment of optimal methods of recovery and treatment;
• determination of the effectiveness of treatment;
• the use of methods to prevent the occurrence of recurrence of schizophrenia;
• the use of rehabilitation methods for the return of a person to a full life.

Signs and symptoms of paranoid schizophrenia

The main symptom of paranoid schizophrenia is nonsense. These are persistent similar installations that lead to a misconception about the world. With this mental pathology, delusions are mixed. This and the feeling of persecution, when the patient feels that he is involved in some business for which he can be punished. Brain of high origin: a person appropriates non-existent regalia. Hypochondriac delirium in paranoid schizophrenia is an artsy character and has little to do with reality. For example, the patient claims that they introduced computers inside the body, which disrupt the work of the organs. In addition, there can be love delusions, jealousy, dysmorphophobia (non-existent physical deficiency) and others. With the progression of the disease nonsense is built up in a clear systematic chain.

Hallucinations can join delusions. This is a distortion of perception when a person perceives something that is not in the real world. Auditory hallucinations are most common: voices that only a person hears. They criticize the patient, argue among themselves, are threatening, forcing a person to do what he does not want. If visual hallucinations join, the patient is even more detached from reality.

Among other disorders of paranoid schizophrenia, note:

• senesthopathy- bodily sensations, not having a physical justification;
• depersonalization – a disorder of perception of oneself, with the alienation of one’s personality;
• social fenced off and care in your inner world;
• emotional inadequacy, anxiety, sleep disorders, and other common mental disorders.

In paranoid schizophrenia, thinking remains safe for a long time. Just a small degree develops negative symptoms: rarely suffers will and emotional devastation is almost not expressed. Therefore, this group of patients for a long time maintains efficiency and commitment to socially approved actions: the creation of a family, the birth of children and others.

Most often, schizophrenia begins with auditory hallucinations, which are subsequently supplemented by visual. Brad is characterized by a distorted reflection of the surrounding world, which becomes a reason for misunderstanding of situations and a source for the development of false judgments and assessments.

Differential diagnosis

For the correct diagnosis of paranoid schizophrenia, it is necessary to exclude the likelihood of developing delusional disorder, acute transient psychotic and schizoaffective disorders, dementia and other organic personality disorders.

Medical history of a famous scientist

In 1958, at the age of 30, the first signs of illness appeared in the famous mathematician John Nash. In the same period of his life, Nash made several discoveries in the field of mathematics. During his life he was treated several times in psychiatric clinics. When his health condition improved at age 34, he got a job at Princeton University.

At the age of 66, John Nash received the Nobel Prize in Economics. Thanks to the research of John Nash in mathematics, a new scientific approach.

The scientist learned to live with a diagnosis of paranoid schizophrenia. And this did not prevent him from achieving success. The story of his life became the basis of the film “Mind Games”.

How to beat schizophrenia?

Treatment of schizophrenia is the use of a whole range of methods: drug treatment, psychological support, the use of psychotherapy and social rehabilitation.

Treatment of paranoid schizophrenia

The first attack may mean the beginning of a long-term mental illness, and may never happen again. The success of treatment depends largely on the time of detection of the disease: the earlier signs of schizophrenia are detected, the faster the treatment begins, the greater the likelihood for a positive prognosis and the greater the chances of long-term remission.

Paranoid schizophrenia – fully stopped by modern means!

Anyone who wants to recover and gets the support of loved ones and caring people have all the chances to cure mental illness. According to general statistics, every fifth person in the world who suffers from schizophrenia, with the right approach to treatment, achieves a prolonged remission of 5 years or more. These people become full-fledged members of society and a reliable support in their family.

Studies show that if a patient participates in a special psychotherapy program, the likelihood of a patient’s long-term remission increases dramatically.

Treatment of schizophrenia takes place under the supervision of a psychiatrist with the use of medicines (neuroleptics), psychotherapeutic methods under the guidance of a psychotherapist and a clinical psychologist. During treatment, the client undergoes a compulsory rehabilitation course in the hospital and after discharge.

Prognosis in the treatment of schizophrenia

90% of patients achieve a high degree of remission and can live and work on minimal doses of drugs supporting drug therapy. Even in the case of long-term medication, patients can lead a normal life and fully realize their potential. For this, a rehabilitation course is needed, in which the patient and his relatives participate. Statistics show that very often people who have suffered a disease, can return to a rich life and become even more productive than the average person.

The brain of the townspeople and people living in the village reacts differently to stressful situations, scientists from Canada and Germany write in an article published Thursday in the journal Nature.

Life in the city, on the one hand, increases the risk of various diseases, but it also has advantages: inhabitants of policies usually earn more living in rural areas, here modern methods of treatment are more accessible. However, from the point of view of mental health, citizens are much more vulnerable than the villagers: neurotic and mental disorders, in particular, schizophrenia, are much more common among the former.

Group led by Andreas Meier-Lindenberg from the University of Heidelberg (Germany) decided to investigate the biological mechanisms that are behind the increased mental vulnerability of citizens.

To do this, scientists with the help of functional magnetic resonance imaging investigated how the brains of people with varying degrees of “urbanization” react to stress – from those born in the city to those who arrived there at a mature age.

In the course of the experiment, 32 volunteers had to press the buttons to choose the correct answers to the arithmetic problems that appear before their eyes on the displays of special glasses, under severe time constraints. The researchers at the same time through the headphones “criticized” them for poor performance of the task.

The stress level of the subjects was monitored at different stages of the experiment by measuring the content of the hormone cortisol in saliva, as well as pressure and pulse.

It turned out that in people with varying degrees of urbanization, different parts of the brain are activated in response to stress. For subjects currently living in the city, the stress “included” the amygdala in the brain, with the degree of activation increasing, from low in those living in small towns to much higher in those living in megalopolises.

In subjects who grew up in the city, but moved to the countryside, the center of activity under stress was located in another area of the brain – the cortex of the gyrus, which controls the emotional state.

“This discovery means that different regions of the brain are sensitive to the experience of living in a city at different periods of life,” says one of the authors of the study, Jens Prussner (Jens Pruessner) of Canadian McGill University.

According to him, this work allows us to better understand the risks that the urban environment poses to people’s mental health. Scientists intend to further explore the relationship between the observed effect and mental disorders.

The brain of the townspeople and the village reacts differently to stress

Life in the city is associated with an increased risk of increased anxiety, depression and schizophrenia, reports Live Science. Testing the brain of students who grew up or live in large cities allowed scientists from the University of Heidelberg (University of Heidelberg), Germany, to determine which parts of the brain are responsible for the stress response to the urban environment and lifestyle. Their article was published on June 22 in the journal Nature.

It has long been known that life in the city as a child two or three times increases the likelihood of developing schizophrenia, and a person who migrates to the city as an adult increases the risk of heightened anxiety and other personality disorders by 21% compared with rural residents.

To establish how the city changes the human brain, scientists scanned German students at a time when they were under severe stress: they were asked to decide an exam in which they could give no more than a third of the correct answers. The students were informed that they had passed the worst exam, and they also put pressure on them, constantly reminding them how important it is to pass the exam well.

It turned out that students who lived in urban conditions, in response to stress, increased activity in the anterior part of the cingulate gyrus of the cerebral cortex, and those who lived in cities in early childhood, increased activity in the amygdala. Both of these sites are responsible for the reaction to stress and in many ways help each other work. The researchers considered the behavior of the brain of a rural resident to be normal.

Now scientists want to establish what the urban environment should be so as not to cause a stress reaction in the brain. Their theory is that increasing the number of green areas and a more environmentally friendly environment can significantly reduce the pressure on the urban dweller, and thus improve his mental health.

However, the environment in which a person is located only increases the risk of developing mental illness. The causes that cause these diseases are most likely related to genetics. According to Around the World, a team of scientists led by Professor Douglas Blackwood (Douglas Blackwood) from Edinburgh University (University of Edinburgh) Scotland allegedly found a gene responsible for mental illness

It turned out that people suffering from schizophrenia, clinical depression or bipolar disorder, “silent” gene ABCA13. Two years ago, scientists from the Institute of Neurology in London (Institute of Neurology in London) and their colleagues discovered the genes responsible for the occurrence of dementia (dementia). This common disease is caused by damage to the GAB2 gene, which is usually associated with the APOE4 gene.

Brain electrical stimulation can cause symptoms of schizophrenia

Simple electrical stimulation of certain parts of the cerebral cortex can cause obtrusive hallucinations in a patient, resembling the symptoms of schizophrenia. An unusual effect was discovered and described by the staff of the Swiss State Polytechnic School. A study report published in the journal Nature.
A strange side effect was observed in the treatment of a 22-year-old woman who suffered from epilepsy and who had no previous mental health problems. The patient was trained for surgery to remove the epileptic seizure-causing scar tissue formed after a brain injury.

Trying to determine the center of epileptic activity as precisely as possible, the doctors applied electronic impulses to the patient’s brain. During the examination, the electrode accidentally touched the temporal-parietal region of the cortex, which is responsible for coordinating the body data in space to the brain. As a result, the patient had a steady feeling of the presence of a dark figure behind her back, copying the movements of her body.

The doctors who treated the woman decided to understand what was happening and repeated electrostimulation of the temporal-parietal region several times. Every time the impact caused the illusion of the presence of the “alien” figure in the patient. When the lying patient was asked to hug her knees, she had the impression that the dark figure was trying to hug her. Despite the fact that the patient was fully aware that what was happening was an illusion, her feelings were very realistic and frightening.

The patient “stranger” standing behind his back and copying the movements seemed to her to be a completely independent person, in no way connected with her body and consciousness.
According to the coordinator of the research project, the illusion recorded during the research can be explained by the projection of information coming in to the brain about the position of the patient’s own body under the influence of electrical impulses.

Observation results clearly indicate that relatively simple switching of electrical signals in the brain can cause complex psychiatric symptoms in mentally healthy people, notes Dr. Blanque. It is possible that a similar mechanism underlies such symptoms of schizophrenia as a split personality, an obsessive sense of subordination to someone else’s will, the perception of members of their own body as belonging to others, etc.

In the near future, scientists are going to reproduce the observed effect in clinical studies involving several healthy volunteers.

At this point in time   The diagnosis of “schizophrenia” today is made on the basis of subjective data that rely on the patient’s observations and research on his experiences – that is,   phenomenological level.

Brain tests after smith patients show that in schizophrenia there can be various   neuropathological processes. But new methods used in the practice of neuroimaging are not yet effective enough to reveal such a pathology in this disorder.   At   their use   not fixed and   functional,   and morphological changes in the brain.

Some functional neuroimaging techniques identify specific changes in the frontostriatal and frontolymbic regions of the brain in schizophrenia. Moreover, these changes were detected at the beginning of the disease, and during the manifestation during the first episode of psychosis.

Neuronal dysfunction underlies cognitive impairment in schizophrenia.

• Dysfunction of the prefrontal cortex in schizophrenia

Many symptoms of schizophrenia   associated with the defeat of various areas of the prefrontal cortex. For example,   deterioration of working memory and other test scores are associated with insufficient activity   dorsolateral prefrontal cortex.

Functional neuroimaging in schizophrenia, confirming a decrease in the activity of the prefrontal dorsolateral locus, which is confirmed by special tests (Perlstein et al., 2003).

Numerous studies indicate increased activity in the dorsolateral prefrontal cortex in patients with schizophrenia. When performing complex tests, for example, split ringtones that require some effort, these changes become more pronounced. With simple tests, an increase in the activity of the cortex of the dorsolateral prefrontal region of the brain is observed;   Complicated tests decrease activity of this department, if schizophrenic patients do not perform these tests. (Callicot et al., 2003).

Reduction   activity of the dorsolateral prefrontal cortex leads to an executive response deficit   in patients with schizophrenia. And the deficit in selecting answers with a corresponding sense of success, with concomitant reward, is associated with the ventral and orbitofrontal areas of the prefrontal cortex.    (Chemerinski et al., 2002).

Reduced prefrontal activity associated with reduction   responses to stimuli that enhance motivation, as the neural networks of the amygdala, which are projected, are suppressed   on the prefrontal region (Paradiso et al., 2003).

Strengthening the motivational aspect when choosing an answer is associated with the lower or orbitofrontal region, which play a role in the process of choosing one or another solution of problems associated with tests for inappropriate behavior.

Healthy people   The interaction between the dorsolateral and ventral and prefrontal cortex provides a balance between test responses based on choice and the motivation to inhibit inadequate responses. And in schizophrenic patients, this interaction is destroyed.

In patients with schizophrenia   interaction   between the lower and dorsal foci of the prefrontal area   affects pathological activity in the anterior cingular region, which is also involved in monitoring responses.

These data suggest that dysfunction of the prefrontal cortex is observed in schizophrenia, which leads to clinical and cognitive symptoms.

• Dysfunction of the temporal cortex

Reduced activity of the temporal cortex   schizophrenia revealed by many scientists. This is established both by functional neuroimaging ,   and electrophysiological studies, as well as in the process of conducting auditory tests for selective attention.

A progressive deficit in the activity of the temporal cortex has been identified in schizophrenia by many researchers. Functional neuroimaging and electrophysiological studies also revealed pathological foci. The research results revealed a decrease in ties   between the frontal and temporal cortex of the brain that was associated with   results of the auditory test.

Functional deficiency of the limbic cortex and pathology of the midbrain

The limbic system of the brain is represented by the area of the cortex on the medial side of both hemispheres of the brain, and includes the amygdala and hippocampus . Limbic system   involved   in the cognitive process, and also associated with taste, eating behavior, aggression, expression of emotions, sexual behavior.

In patients with schizophrenia, the content of dopamine in the limbic system is increased , especially in the left amygdala of the brain.

Dopamine receptor increase   also found in patients with schizophrenia in the area of the visual mound. Based on these data, it can be said that diagnostic methods based on phenomenological   level, will soon be a thing of the past.

Hallucinations and delusions as symptoms of schizophrenia

Hallucinations and   rave   – it is alone of major signs acute frustration psyche . Wrong to call them   only signs of schizophrenia, since they can accompany and   other mental illnesses. Exactly so at treatment patient having similar symptoms , extremely is necessary thorough medical survey and   differentiated diagnostics .

But   here we   will consider these phenomena exactly in   framework given disease, where they are positive ( productive ) symptoms schizophrenia . Thats   there is   the picture diseases appears   what not   can be at   man in   normal.

Let’s start with   that hallucinations and   delirium in schizophrenia   These are signs of acute psychosis that require immediate treatment.   qualified psychiatric care. Need to remember that on   further course of the disease affects   how timely and   its acute manifestation was stopped. The faster the patient’s relatives take care of   rendering assistance, the more favorable the prognosis. A gross mistake is   what   for some reason, relatives expect that the symptoms of schizophrenia will disappear   yourself, or about   there is simply no one to take care of the patient, and   then the acute psychotic state continues to progress. Naturally in   In this case, it is becoming increasingly difficult to stop it.

Hallucinations in schizophrenia

When diagnosing schizophrenia, auditory hallucinations are most often detected when a person hears those   or other sounds or voices that are not in   objective reality. Voices most often first comment on a person’s actions, then they can begin to criticize him, threaten him, and   by   as psychosis unfolds, even ordering to commit those   or other actions. It is very dangerous, in   first of all, for the patient himself, since he   can harm itself or people surrounding it, trying, for example, to be protected from   not   existing objectively but   available in   his distorted picture of the world, danger.

Signs of hallucinations :

• the man suddenly becomes silent, starts toto listen to anything
• talking tomyself (here, naturally not include man’s thinking out loud or comments on about anything he perceives or experiences in currently in reality, for example, “Where did this book disappear … “),
• sudden,causelesslaughter,
• increasing closure, inability to focus on

Delusional disorder in schizophrenia

Rave   – one more of   acute signs of schizophrenia. These are certain beliefs of a person or his conclusions that are not   match what surrounds it in   reality. This is the most inconsistency of reality   – one of   The first signs that an idea, a belief are delusional. The second feature of delirium   – her   sustainability and   the fact that no third-party reasonable counterargument given ideas   give in

According to statistics, order   80% of people with schizophrenia? suffer from various kinds of delusions.

By   Crazy ideas can be different in their content. So, classified:

• Delusion of relationship (observed most often). The person feels like the center of all the phenomena around him and   events: the actions of all, even completely unfamiliar and   randomly passing people expressing them   persons driving past cars and   other things.
• Brad of pursuit when the patient is sure that certain people / people / organizations intend to cause him some damage, are watching or are already causing some harm (neighbors are poisoned by gas, relatives pour in   food poison   and   other).
• Nonsense effects (mental or physical), when a person is convinced that his thoughts, actions, experiences are not connected with   his inner personal motives as well   are the result of the influence of some external force: witchcraft, hypnosis, cosmic rays.

Less common but   So   other types of nonsense can occur.

The productive symptoms of schizophrenia may increase gradually or appear suddenly. Regardless   the rate of unfolding of such an acute condition in schizophrenia, you must immediately apply for   medical care. Remember: a person with such manifestations of the disease is often not   able to ask about   aid because the picture of the world and   perception of his own state for him is very much distorted. Especially if this is the first attack, the manifestation of schizophrenia.

High-quality relief of such conditions is impossible outside the hospital. The sooner assistance is provided, the more favorable the further forecast will be.

State of the Vegetative Nervous System in Schizophrenia

In patients with schizophrenia, especially before the period of psychosis and in the subacute period, there are changes in the vegetative nervous system. This requires attention during the diagnosis and treatment of a mental disorder.

The first sign of the development of schizophrenia is a dysfunction of the autonomic nervous system. This is manifested in the presence of pathological processes in the cardiovascular system, gastrointestinal tract, sleep disturbance, sleep cycle disturbance – sleep / wakefulness, etc. Therefore, when psychosis occurs, it is necessary to prescribe medications that affect the autonomic nervous system.

The results of studying the parameters of the autonomic nervous system in patients with schizophrenia indicate that they have a predominant parasympathetic system over the sympathetic one.

Of course, the appointment of substances toning the sympathetic nervous system should reduce the symptoms of schizophrenia, however, at the peak of psychosis, fluctuation in tone and predominance of the sympathetic nervous system over the parasympathetic with affective-delusional symptoms, also increased parasympathetic nervous system – with catatonia, which reduces the effectiveness of sympatomimetic drugs and prompts the use of drugs that stimulate the parasympathetic system.   It follows from this that the use of sympathicotonics during remission of schizophrenia may occur with the aim of preventing the recurrence of psychosis. It is known that medications of the vagoparalytic group, in particular atropine, were previously used in the treatment of neurosis-like , sluggish forms of schizophrenia, and pilocarpine could provoke a relapse of psychosis.

Observations on patients with schizophrenia during remission showed that the duration of remission can be predicted by the severity of the tone of the sympathetic nervous system.

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.

The reasons

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.

Symptoms

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:

• stupefaction,
• involuntary fantasizing about space travel, global catastrophes,
• stupor
• confusion
• incoherence, meaninglessness of speech,
• delirium
• 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,
• bruises,
• 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

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:

• stunning
• tachycardia,
• 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.

Schizophrenia is a disease that has a biological nature, its manifestations that eliminate the effects on the metabolism of biologically active substances in the brain.
Since the discovery of the first psychotropic drug aminazine in the 50s of the 20th century, there has been a revolution in the treatment of mental disorders, especially schizophrenia. Until that time, the most popular methods for treating schizophrenia were insulin therapy, electroconvulsive therapy and lobotomy. Drug treatment to a greater extent was symptomatic and usually included sedative drugs.

With the advent of neuroleptics, the possibility of chemical exposure to it and the elimination of symptoms appeared, whereas before such patients had to be isolated from society in anticipation of short-term spontaneous remissions.

Modern pharmacology, including in the open air. These drugs are called “neuroleptics” or “antipsychotics.” They have one thing in common – they all, first of all, eliminate the manifestations of psychosis: delusions, hallucinations, psychomotor agitation. The mechanism of their action is the blockade of receptors to the mediator – a biologically active substance of the brain – dopamine, thanks to this and the appearance of the antipsychotic effect of drugs. In addition, they have affinity for other receptors (for acetylcholine, adrenaline, serotonin, histamine), which explains a fairly wide range of their actions, including the occurrence of some side effects. There are many classes of neuroleptics that differ in chemical structure, which means that they affect the body in different ways, to a greater or lesser extent, affect the various manifestations of schizophrenia.

Action of neuroleptics

The actual antipsychotic action of neuroleptics is distinguished: the general effect on all manifestations of psychosis and the prevention of further development of the disease, and the selective effect on the productive symptoms (delusions, hallucinations, obsessive states, catatonia). Due to the sedative (retarding) action, antipsychotics are effective in various types of psychomotor agitation and insomnia. Some neuroleptics, on the contrary, have an activating effect, it is used in the treatment of negative symptoms (apathy, catatonic stupor, autism).
Cognitropic action is an effect on higher cortical functions (memory, attention, thinking, perception). Neuroleptics also have a neurological effect – they are associated with dopamine receptors, which are located in the centers of regulation of movements, which cause such side effects as muscle stiffness, restlessness, trembling limbs . These adverse events are eliminated by the appointment of correctors, such as cyclodol or akineton.

Neuroleptics also affect the autonomic nervous system and the endocrine system, which can manifest dry mouth, delayed urination, lowered blood pressure, decreased sexual desire, menstrual disorders, weight gain. In different groups of neuroleptics, the listed effects are expressed in varying degrees, and the use of a particular class of drugs depends on the form of schizophrenia and the characteristics of its course.

Recently, preference is given to the modern class of neuroleptics, which appeared in the 90s of the 20th century, the so-called “atypical” neuroleptics. They are atypical because, unlike previous generations of drugs, they practically do not have a neurological effect, i.e. do not cause side effects associated with movement disorders, which is a very valuable quality, because Movement disorders usually deliver great discomfort to patients and require the appointment of additional drugs-proofreaders. At the same time, modern antipsychotics are as effective in eliminating the symptoms of schizophrenia as the old drugs. Another advantage of atypical neuroleptics is their positive effect on cognitive function (cognitotropic action), which was not the case with drugs from previous years; due to binding to serotonin receptors in the brain, atypical antipsychotics also have an antidepressant effect.

Modern drugs are easy to use – the characteristics of their distribution in the body are such that they can be taken only once a day. With regular intake, the drugs begin to fully operate in 2-3 weeks, so they need to continue to be taken, even if at first glance there is no expected effect. However, at the peak of the drug’s action, not all symptoms of the disease can be immediately eliminated, for a complete reduction of symptoms and for the prevention of recurrence of the disease, medicines should be drunk on average for two years.

For the convenience of long-term use of drugs released prolonged forms of neuroleptics in the form of injections  – one such injection lasts for 2-4 weeks. In addition to the elimination of specific schizophrenic symptoms, it is useful to have a general strengthening treatment, since the disease is usually accompanied by general disorders of the nervous system. For this purpose, drugs that improve metabolism in the nervous tissue are used: picamilon, mexidol, cerebrolysin, milgam, mildranate, gliatillin, nootropil.

Drug-resistant Schizophrenia Therapy

The main problem that may arise during the treatment of schizophrenia is drug resistance (resistance). This phenomenon is rare, however, it can occur in certain forms of schizophrenia, metabolic features of the patient, or prolonged and inadequate treatment with psychotropic drugs. In such cases, as well as to break the acute attacks of schizophrenia with delusions and catatonia, electro-convulsive therapy (ECT), insulin-comatose therapy, hemosorption and plasma exchange, laser irradiation of blood are used.

Electroconvulsive therapy sessions are performed in the intensive care unit under general anesthesia to minimize the risk of complications. Electrodes are applied to the patient’s head and artificially cause a convulsive fit. The treatment includes 4-8 sessions of ECT, patients completely forget seizures, and the effectiveness of this method can be quite significant. Another method of shock therapy for schizophrenia is insulin therapy. This technique is based on the introduction of insulin doses to achieve a hypoglycemic coma (loss of consciousness due to a decrease in blood sugar), 10-20 minutes after reaching the coma, the patient is removed from it by intravenous administration of a glucose solution. In order to break the attack of psychosis requires 10-20 sessions.

Sometimes it is effective to use detoxification (purification from toxins) of an organism using hemosorption or plasmapheresis. The blood of the patient is driven through a special apparatus, where it is cleaned of toxins, immune complexes, in the case of long-term drug therapy – of drugs. This can help both to reduce the manifestations of productive schizophrenic symptoms and to overcome drug resistance due to the “cleansing” of receptors. Similar exposure has blood irradiation with a laser.

The listed methods of the so-called “non-medicinal” therapy are used in extreme cases of intolerance, drug resistance, or for the termination of acute psychosis. In all other cases, there is enough drug therapy. Also, for greater efficacy, a combination of drug therapy with non-drug therapies is possible.

With the modern development of psychiatry, when it is possible to conduct therapy with modern drugs, with timely access to a doctor (no later than 2 years after the first symptoms of the disease appear), with prescribing adequate drug therapy and following the regimen of drugs, it is possible to conduct effective treatment with a minimum of side effects elimination of schizophrenic symptoms and defects that the disease managed to cause the patient’s personality. With a long-term disease it is possible to achieve a significant improvement in the condition and prevent further development of the disease process.

At the same time, a single biological therapy for effective treatment of schizophrenia is clearly insufficient and requires mandatory psychotherapy (individual, group, family), psychological correction of memory disorders, attention, thinking, as well as a set of social measures aimed at rehabilitating a person suffering from this disease.

Pregnancy during schizophrenia

In recent years, women with schizophrenia are not afraid to have children and successfully perform the functions of mothers . This is due to the new principles of treatment and care for such patients, as well as the use of atypical antipsychotics.

It is difficult for a psychiatrist to lead such pregnant women, it is also difficult for gynecologists. There is a risk of complications for the mother and fetus, and it is caused both by the possibility of recurrence of schizophrenia, and the effect of psychotropic drugs on the fetus.

It is known that for the first fifteen years after the onset of schizophrenia, a woman leads an active social and sex life. And pregnancy does not protect and does not protect against exacerbation of the disease. A woman may refuse to take psychotropic drugs, but the risk of relapse is great.

Schizophrenia can begin during pregnancy, but such cases are rare. Most often there are personality disorders. But if schizophrenia occurs during pregnancy, then the further development of psychosis will be unfavorable. In such patients, preterm labor is more often recorded, and the child has a low body weight.

Schizophrenia can cause congenital abnormalities and perinatal mortality. Patients with schizophrenia are advised to become pregnant one year after the onset of this disease. Hormones can be a means of contraception ( depomeroxyprogesterone ), but against the background of their administration, relapses of schizophrenia or depression are possible.

Oral contraceptives can interact with nicotine and psychotropic drugs ( clonazepine ), increasing the level of their concentration in serum. The use of first-generation antipsychotics, such as haloperidol , is considered safer than taking atypical antipsychotics.

The abolition of antipsychotics in the first 6-10 weeks of pregnancy can be practiced only in patients with mild forms of schizophrenia. Antipsychotics should be used in the minimum effective dose, while controlling the level of the drug in the blood. When treated with olanzapine and clozapine, CYP 1A2 activity of cytochrome P450 decreases during pregnancy.

Hallucinations and delusions as the symptoms schizophrenia

Hallucinations and   rave   – This is one of the main signs of acute mental disorders. Wrong to call them   only signs of schizophrenia , since they can accompany and   other mental illnesses . That is why in the treatment of a patient with similar symptoms, it is imperative that a thorough medical examination   differentiated diagnosis.

But   here we   Consider these phenomena precisely in   within this disease, where they are positive ( productive) symptoms of schizophrenia. Thats   there is   picture of the disease appears   what is not   maybe u   man in   norm

Let’s start with   that hallucinations and   delirium in schizophrenia   These are signs of acute psychosis that require immediate treatment.   qualified psychiatric care . Need to remember that on   further course of the disease affects   how timely and   its acute manifestation was stopped. The faster the patient’s relatives take care of   rendering assistance, the more favorable the prognosis. A gross mistake is   what   for some reason, relatives expect that the symptoms of schizophrenia will disappear   yourself, or about   there is simply no one to take care of the patient, and   then the acute psychotic state continues to progress. Naturally in   In this case, it is becoming increasingly difficult to stop it.

Hallucinations at schizophrenia

When diagnosing schizophrenia, auditory hallucinations are most often detected when a person hears those   or other sounds or voices that are not in   objective reality. Voices most often first comment on a person’s actions, then they can begin to criticize him, threaten him, and   by   as psychosis unfolds, even ordering to commit those   or other actions. It is very dangerous, in   first of all, for the patient himself, since he   can harm itself or people surrounding it, trying, for example, to be protected from   not   existing objectively but   available in   his distorted picture of the world, danger.

Signs of hallucinations :

• the man suddenly becomes silent, starts to to listen to anything
• talking to myself (here, naturally not   include man’s thinking out loud or comments on   about anything he   perceives or experiences in   currently in   reality, for example, “Where   did this book disappear … “) ,
• sudden , causeless laughter,
• increasing closure, inability to focus on

Crazy disorder at schizophrenia

Rave   – one more of   acute signs of schizophrenia. These are certain beliefs of a person or his conclusions that are not   match what surrounds it in   reality. This is the most inconsistency of reality   – one of   The first signs that an idea, a belief are delusional. The second feature of delirium   – her   sustainability and   the fact that no third-party reasonable counterargument given ideas   give in

According to statistics, order   80% of people with schizophrenia? suffer from various kinds of delusions.

By   Crazy ideas can be different in their content. So, classified:

• Delusion of relationship (observed most often). The person feels like the center of all the phenomena around him and   events: the actions of all, even completely unfamiliar and   randomly passing people expressing them   persons driving past cars and   other things.
• Brad of pursuit when the patient is sure that certain people / people / organizations intend to cause him some damage, are watching or are already causing some harm (neighbors are poisoned by gas, relatives pour in   food poison   and   other).
• Nonsense effects (mental or physical), when a person is convinced that his thoughts, actions, experiences are not connected with   his inner personal motives as well   are the result of the influence of some external force: witchcraft, hypnosis, cosmic rays.

Less common but   So   other types of nonsense can occur.

The productive symptoms of schizophrenia may increase gradually or appear suddenly. Regardless   the rate of unfolding of such an acute condition in schizophrenia, you must immediately apply for   medical care. Remember: a person with such manifestations of the disease is often not   able to ask about   aid because the picture of the world and   perception of his own state for him is very much distorted. Especially if this is the first attack, the manifestation of schizophrenia.

High-quality relief of such conditions is impossible outside the hospital. The sooner assistance is provided, the more favorable the further forecast will be.

Recommendations relatives the sick schizophrenia

what to do if a loved human schizophrenia

What should be the sequence of your actions if   whom   Something   of   do people close to you have schizophrenia? Talk to   an experienced doctor. Remember that timeframes play an important role and   in   largely determine the success of therapy. The most common treatment for schizophrenia is to start at   hospital, it should include   making an accurate diagnosis, since there are quite a few options for the manifestation of schizophrenia. It is desirable that the situation around the patient with schizophrenia should be calm (one or two local chambers), so that the doctor who assists should master modern methods of psychotherapy. It is unacceptable to provide the patient with schizophrenia to himself, to exclude that   activity that was interesting to him. Schizophrenic activity should be encouraged by qualified personnel who know not   only medicine but   and   psychology. AT   In some cases, it is important to strengthen the strength of the patient with schizophrenia, choosing a good nutrition for him, adequate physical therapy, massage , physiotherapy and   balneotherapy Around a schizophrenic patient should not be   only experienced doctors but   and   specially trained psychologists, social workers.

how to lead yourself with the sick schizophrenia

It is known that the course of schizophrenia is chronic, i.e. stretched in time. Despite the ongoing treatment (even with modern drugs), mental and behavioral disorders in schizophrenia are marked for a long time. Proper treatment of the patient by his close environment has a significant impact on the outcome of therapy.   Below is a list of some techniques available to everyone that facilitate rehabilitation .

Do not rush. The process of restoring health can be lengthy.

• Keep calm. Excessive enthusiasm is normal, however, try to temper it. Dissent is also common. Try to take it easy.
• Explain easier. Say what you want to say clearly, calmly and confidently.
• Set limits. Everyone should know the rules. A few simple rules will help put everything in its place.
• Follow the doctor’s instructions. It is necessary to take medications as he prescribed, and only those that he prescribed.
• No drugs and alcoholic drinks to the patient.   schizophrenia! They aggravate the symptoms diseases .
• Pay attention to all changes in well-being. If possible, write down and report them to the consulting physician.
• Solve problems step by step. Make changes gradually. Work on one thing.
• Let’s rest each other. Everyone needs a break. You are tired of something – it happens. Fine also sometimes to say “no.”
• Do not think about what you can not change. Something needs to be left as it is. but not leave without attention manifestations cruelty .
• Do all your business as usual. Restore the usual order of housework. Support connection with by their relatives and friends .
• Temporarily lower your expectations. Use your own impressions, comparing the results of treatment (rehabilitation) of the current month with the previous one.

What to do?

The links that arise between schizophrenia and violence are shown schematically in fig.2. How can these bonds be broken?

It is tempting to draw up some ideal scheme for easing or eliminating violence as a complication of schizophrenia. Of course, ideally, it would be advisable to early identify inadequate education and take measures to eliminate the causes of this in all children, and not only in 0.5–0.8% who may develop schizophrenia. Similarly, problems in interpersonal relationships, behavioral disorders and inadequate performance by parents of their duties would be desirable to consider in childhood in order to eliminate these causes or at least weaken their influence. Some researchers call for the detection of pre-psychotic states and early intervention ( McGorry et al , 2005). But the impact on these complex phenomena goes far beyond our capabilities as doctors, and probably also – until more compelling data is obtained in favor of the effectiveness of early interventions – beyond our ability as scientists to effectively support them. Then what are the clinical implications for everyday practice?

Modified installation

It is time for the psychiatric community to agree that aggressive and antisocial behavior is a possible complication of the current schizophrenic syndrome.With the recognition that the problem of violence is our sphere, it will be possible to take measures to eliminate its causes.As long as the problem of violence is minimized or ignored as “non-disease related,” it is impossible to make any progress in reducing the risk.It is necessary to recognize individuals at high risk, although they make up less than 10% of the population of schizophrenic patients, and give a correspondingly high priority to organizing the treatment of their disease.But how can they be recognized?

Early detection of high-risk patients

Individuals who are at high risk of violence in the future should be identified, avoiding abusive stigma: it is necessary to ensure that the identification process as the primary clinical task is consistent with the mitigation of their risk factors.Risk assessment is not some kind of mysterious technology that requires expensive specialized training.This is a practical work that should be simple, clinical, multidisciplinary and should be systematically carried out.

SimpleThe high-risk group includes a huge number of young men who have a history of childhood behavior disorder, antisocial and aggressive behavior during adolescence, substance abuse , unemployment, and a disorganized lifestyle.

Clinical.The risk increases dramatically with individuals who show anger and suspicion, are unable to understand the essence of what is happening, reject the therapy, threatening and thoughtless.Specific delusional syndromes, especially jealous rage, dramatically increase the risks – just as much as personality traits such as heartlessness and the conviction of the right to impunity.

Multidisciplinary.No professional group has a monopoly on the knowledge necessary for risk assessment, so everyone must make an appropriate contribution.The current behavior in the hospital, social conditions, mental state, assessments of personality traits and level of intelligence, as well as, most of all, a carefully collected history have a certain meaning.

Systematic. The need for risk assessment in psychiatric practice has led to the development of a variety of tools with widely varying accuracy. This is not the place to discuss the quality of the various checklists. It is best to use dynamic as well as static variables, which will allow you to recognize which factors may be targets for their elimination. Their primary appointment for the doctor is to direct attention to the known correlates of aggressive behavior. Evaluation tools allow you to identify risk groups. However, they do not help with an acceptable probability of error to indicate the chances that a particular individual at high risk will be violent. Therefore, they can be considered good tools for assessing needs and bad ones for justifying checks for the purpose of applying punishment. Evaluation tools, such as HCR – 20 ( Webster et al , 1997), which includes a checklist of questions for evaluating psychopathy, allows us to structure the specialist’s approach to risk assessment, while at the same time not going beyond common sense and leaving room for the application of clinical knowledge.

General principles of patient management

Many high-risk patients are young, substance abusers , treatment-rejecting and disorganized.The organization of treatment for these individuals with schizophrenia depends on whether they have managed to achieve complete abstinence over a sufficiently long period from the use of cannabis and other psychoactive substances that patients have abused.There is little point in hospitalizing for several days or even a couple of weeks, since in most cases the patient will still be under the influence of psychoactive substances that he abuses.

Similarly, hospitalization is unlikely to succeed if the patient has the opportunity to regularly leave for a local dealer or receive visitors bringing him drugs.The effectiveness of treatment depends on prolonged hospitalization (4–8 weeks), which may initially involve the patient in a closed ward.After discharge, few individuals in this group will comply with the regimen of medication, they are also unlikely to voluntarily remain in the housing in which they are supervised.Court guidelines for community treatment may help to adhere to the regimen of medication, but where it is possible, preference is given to the depot preparation.

Given the need to minimize side effects, especially akathisia and dysfunction of the frontal lobe, which may accompany the neuroleptic deficiency syndrome, the second generation of atypical antipsychotic drugs should first be prescribed ( Swanson et al , 2004). At present, choice is limited to deporisperidone , at least until the deposited forms of other atypical preparations become available.

Coercion is unlikely to achieve the desired goal in the long run.If you try to deprive these adolescents of the psychoactive substances they use, alcohol, and the only peer group they have known for a long time and impose drugs on them that they do not believe in and consider them unnecessary, then you must provide them with some substantial compensation. .In the short term, in order to provide different types of activities and to structure their lives, they will need improved housing, regular support from specialists, with whom they have developed good relations, and investments that they value.In the medium term, their cooperation can be supported by programs to improve social interaction, improve production skills, provide recreational activities and play sports.The debt o- term plan for these individuals if they are unable to establish a structured and bring joy to the life of (this applies to employment, leisure or group itself (inter) aid) to remain constant risk of relapse of substance abuse, lower social level and the risk of crime .

A minority of high-risk patients will experience systematic paranoid delusions.At first glance, it seems that they are less of a problem, or at least more familiar, since the main mediator of risk are the symptoms of the disease.However, in fact, they are at least equally suspicious and often do not openly follow the healing recommendations.Perhaps because of the sense of superiority divorced from reality, it is more difficult to interest them and they are more undermining the strength of specialists.In addition, these patients need inpatient medical care with rehabilitation, the use of depot preparations and the subsequent persistent observation of a physician, especially when the coverage of delusions is rather slowly losing its strength, if at all.They, like any other disorganized group, should be assisted in the formation of social skills, the development of responsiveness in interpersonal relationships, in developing an ability to manage anger and, most of all, in effective social reintegration .

Organization of events for the provision of social assistance and labor rehabilitation

Patients at high risk who leave the hospital need permanent housing in areas with low crime rates. This elementary and obvious recommendation seems hopelessly idealistic because of resistance to dormitories, “halfway houses” (institution for the rehabilitation of prisoners who have served their sentences, cured drug addicts, alcoholics, the mentally ill – ed .) diseases, not to mention “perpetrators with mental disorders,” in more privileged areas.The community should not continue to push an undesirable individual to the places where the commission of a repeated offense is in fact predetermined.

Individuals with schizophrenia and a high risk of violence upon returning to the community need both a structural and an active supportive lesson.Repeated offenses are committed less frequently due to employment, stable relationships and mixing with non-criminal peers.The formation of work skills in unmotivated, poorly educated individuals with schizophrenia, who have not had experience in the past, is of great importance.And after the closure of hospitals in the 1960s – 1970s, psychiatric services responded adequately to the problem of rehabilitating patients who were long-term in closed psychiatric institutions.Perhaps the time has come to treat the problem of young people with disabilities who belong to a high-risk group with the same seriousness.

Psychological treatments

Disorders in development, hereditary predisposition and the schizophrenic process itself form in some individuals characteristic features and attitudes that can be called criminogenic.Restricting the ability to exercise violence largely depends on the modification of these factors and the forms of behavior that these factors engender.

Under any circumstances, deep skepticism about the effectiveness of treatment of severe personality disorders persists, especially if they are part of the schizophrenic syndrome. This is partly due to the fact that the favorite methods used recently, for example, dynamic psychotherapy techniques, psychotherapeutic communities, individual work with patients and simplified behavioral psychotherapy techniques, were either ineffective or complex statistical methods were required to prove any of their effectiveness. with special justification. Personality disorders as nosological units are usually incurable, but many components of these disorders are open to modification and improvement. In patients with dangerous manifestations of schizophrenia, it is often possible to improve interpersonal skills, control anger, develop a constructive sense of self-confidence, strengthen sympathy for the victim, and eliminate or mitigate cognitive distortions that support destructive behaviors ( Novaco , 1997; Renwick et al , 1997). You cannot form a harmonious strong pro-social personality, but you can reduce the chances of antisocial behavior in the future ( Hollin , 2003; McGuire , 2003).

Substance Abuse

Evaluation of the abuse of alcohol and other psychoactive substances in individuals with schizophrenia willy-nilly becomes the top priority. Currently, in individuals with a high risk of violence, substance abuse is almost a universal phenomenon, therefore, effective control of it will be a necessary (preliminary) condition for any other treatment. This is not the place to analyze or recommend specific approaches to substance abuse , except that it can be repeated that it should be given the same clinical priority both at the place of residence and in hospital conditions, as well as eliminating or alleviating active psychopathological symptoms. In our service at Thomas Hospital Embling we use numerous approaches aimed at obtaining optimal results, considering the patient’s willingness to change and working within the framework of the concept of harm minimization ( Stanton & Shadish , 1997; Sheils & Rolfe , 2000; Mueser et al , 2003). Substance abuse may not be the main driver of violence in individuals with schizophrenia, but as long as it doesn’t decrease or, I dare to hope, it will not stop, no other preventive method will give a chance for success.

Restructuring of therapeutic goals and help systems

Whatever the theory claims, psychiatric services, especially under pressure, focus primarily on controlling the symptoms of the disease.The fact that this is always enough is doubtful, but in high-risk groups this is absolutely not enough.Substance abuse, personality weaknesses, and social conditions necessary to give equal, if not control psychopathology priority, then at least they should be an essential part of the treatment process.In part, this will depend on new resources, but equally it will require a change in the priorities of mental health services and the expectations of doctors.In order for such therapeutic goals to be completely transformed into a sustainable system of medical care, it will need restructuring and retraining of the specialists working in it.

In order to address the issues of criminality and substance abuse in schizophrenia to have a chance of success, not only the introduction of several special programs should be envisaged – the patient must be fully embraced by the desire for change. The main thing for such a system is the active participation of nursing staff working in the department and at the place of residence of the patient. Top nurses should be aware of and participate in their patient programs. All staff in the department and outpatient services who will interact with the patient should be aware of the current goals and methods of patient management in order to reinforce the work performed during individual and group psychotherapy. Psychotherapy sessions should not be a “black box”, a mysterious act. They should be transparent, correspond to the descriptions in the manual, and the questions “why”, “what” and goals should be known not only to the psychotherapist and the patient, but also to all relevant personnel on a daily basis. This approach provides for significant changes in the established order and power. Nursing staff is central to the therapeutic process; psychologists play a much larger role in evaluating and developing programs for specific patients; social workers and occupational therapists (by Standard Occupational Classification System – SOC: they plan, organize and implement programs aimed at restoring the abilities to work, manage the household and everyday life, and also contribute to the overall independence of people who are unable to work for any reason; included in the section “diagnosticians and medical practitioners” – approx. ed .) occupy a more important place, especially in the management of patients by place of residence. Such changes are a challenge for psychiatrists who, succumbing to temptation, will focus only on the symptoms, thinking only about the problems of the disease. However, if the system should work, psychiatrists should play the leading role, and only by making the biopsychosocial ideology of modern psychiatry a reality , such an approach will achieve the goal.

The effectiveness of introducing such a system into our court hospital and community services has been evaluated in the state of Victoria over the past 18 months. This system is already associated with a reduction in cases of violence in wards and a sharp increase in the duration of work of nurses. However, not in forensic psychiatric, but in general psychiatric services, such restructuring should give the greatest dividends for patients and the wider community of people.

FINDINGS

Schizophrenic syndromes are associated with a high incidence of aggressive behavior. Psychiatric services should work to prevent such incidents for the sake of their patients, as well as for the wider public. In most cases, violence among individuals with schizophrenia occurs in relatively small subgroups, which probably constitute no more than 10–15% of the patient population. These high risk subgroups can be recognized well in advance. However, it is important that even in these subgroups only a few ever commit serious acts of violence. This is the basis for applying risk management techniques that complement medical care and treatment of the entire group, rather than justifying the use of coercive methods and disability to individuals. Violence on the part of representatives of high-risk groups is caused not only by active psychopathological symptoms, but also by such factors as personality weaknesses, a change in social status, and concomitant substance abuse .

In order to prevent future violence, approaches aimed at characterizing the criminogenic personality, meeting the need for employment and / or structured activities, at eliminating substance abuse , as well as promoting a network of adequate and supportive social connections and relationships are necessary . It is problematic to continue tolerating the situation when marginalization occurs individuals at highest risk of aggressive behavior or openly rejected by various services. To suggest that they necessarily receive better help only because the likelihood of patient aggressive behavior is higher is problematic to the same extent. However, as soon as we, as mental health professionals, are prepared for the fact that coping with violence is part of the real goals of our work, the problem will become an issue of an adequate level of medical care and treatment for specific violations, and not the best or worst services for any particular individual .

Substance Abuse

A great many people, especially in the USA, believe that the main stimulant of crime and violence in individuals, both with and without mental illness, is substance abuse . Epidemiological data on schizophrenia confirm the correlation between substance abuse and criminal activity (Swanson et al , 1990; Steadman et al , 1998; Soyka, 2000; Steele et al , 2003; Wallace et al , 2004).

Individuals with schizophrenia who abuse alcohol and other psychoactive substances are currently responsible for the majority of offenses, and data from some studies suggest that the incidence of violence among individuals with schizophrenia, but without problems associated with the use of psychoactive substances, is not higher. than in control population samples ( Monahan et al , 2001). The authors of the influential MacArthur study even believed that schizophrenia without concomitant substance abuse is a protective factor against aggressive behavior ( Steadman et al , 1998).

Given the authority of Steadman and his co-authors, this judgment has become generally accepted. However, as mentioned, amending the mediating factor actually amends the effect of schizophrenia. Moreover, you can conclude that the very substance abuse is a causative factor only after excluding the possibility that violence, and substance abuse are mediated – wholly or partly – a common third factor torus.

The most likely candidates for such a third factor are personality traits. and / or social conditions.

The McArthur study concluded that individuals with schizophrenia who did not abuse psychoactive substances were no more aggressive than other members of society, was refuted by research results that explored larger groups of individuals who did not abuse psychoactive substances (Vevera et al , 2005).

For example, a study of 2,861 individuals with schizophrenia, consistent with the population control group and first hospitalized over a 25-year period, showed that although during these years the incidence of known cases of substance abuse among patients increased from 8 to 27%, the conviction rate for violence increased only moderately (from 6 to 10%), which corresponds to an increase in the control group (from 1 to 3%) ( Wallace et al , 2004). In this article, it has been suggested that over the past 30 years, more and more people with schizophrenia who are prone to violence have begun to abuse psychoactive substances, and not that the incidence of violence manifested by schizophrenic patients has increased in accordance with the increase in the level of substance abuse . This explanation is supported by the results of a study conducted by two groups: Tengström and his colleagues. (2004), as well as Vevera and his colleagues (2005).

Reducing the incidence of substance abuse among individuals with schizophrenia is an important therapeutic goal, essential for improving both the control of symptoms of the disease and the quality of life. Although this will almost certainly contribute to reducing the number of cases of antisocial behavior, this is far from a panacea for violent inclinations.

Deinstitutionalization

If you believe the popular press and some politicians, the root of the problem of crime among people with severe mental disorders is in deinstitutionalization and in the insolvency of community health care. In a single study that examined the problem of crime among individuals with schizophrenia during the period of deinstitutionalization and the introduction of community health care, there was no evidence for an increase in the number of offenses compared to their frequency in the general population ( Mullen et al , 2000; Wallace et al , 2004). True, it must be admitted that this took place in the locality in which adequate funding was provided for the transition period, and during the study it remained an integrated service rationally provided with sufficient resources. Studying a less organized and worse funded deinstitutionalization process could have other results. However, this illustrates only that ineffective assistance – at the place of residence or in a psychiatric hospital – gives unfavorable results. There is currently no scientific basis for attributing to the deinstitutionalization any increase in crime. Those of us who have worked in large psychiatric hospitals know that their strong point was the strict formation of institutionalized groups and not representing the risk of incapacitated, rather than antisocial and aggressive patients, who then, as now, often ended up in prison.

Active psychopathological symptoms

Considerable clinical experience and numerous literature data confirm the link between active psychopathological symptoms and antisocial behavior, although not all studies support the role of such specific manifestations as delusions and hallucinations ( Hafner & Boker , 1982; Taylor , 1985; Appelbaum et al , 2000; Arsenault et al , 2000). Negative symptoms can perform the protection function even hydrochloric (Swanson et al , 2006).

The assessment of the role of active psychopathology in the manifestation of violence in individuals with schizophrenia, in my opinion, is overstated, but the fact that it plays a certain role is beyond doubt. For example, evidence of a link between jealous rage and assaults against a partner is fully proven, and persecutory delirium, hallucinations, and nonspecific psychotic arousal sometimes provoke violence ( Mullen , 1996; Foley et al , 2005).

A model of two types of violence in schizophrenia is gaining increasing support ( Steinert et al , 1998; Gje et al , 2003). Individuals who demonstrate the first type of violence usually have a systematized nonsense associated with violence, they do not have clear anamnestic data on behavior disorder or offenses during the period of adulthood, they usually commit the first violent crime after admission to treatment, almost always attack a person who assists them or cares for them, or for a friend, and – perhaps most importantly – they are “similar ” to the sick.

Individuals with the second type of violence usually have disorganized clinical syndromes, a history of behavioral disorder, early onset of substance abuse , and, as a rule, they commit violent and non-violent offenses before diagnosing mental disorder, resorting to violence in the family and outside the home and “Similar” to criminal offenders. Most cases of violence among individuals with schizophrenia can be attributed to the second type, although it is possible that the first type of violence is over-represented among the killers.

Consequences of psychopathological symptoms in schizophrenia

Some disorders that make up the schizophrenic syndrome are found from an early age. Schizophrenia can affect the risk of aggressive behavior through three types of vulnerability.

• the types of vulnerability that precede the development of active psychopathological symptoms;
• types of vulnerability acquired due to the active course of the disease;
• types of vulnerability imposed by the results of ongoing treatment and management.

Of the examples listed in Box 1, attention should be paid to the early onset of substance abuse , since one of the most common clinical errors is the diagnosis of psychosis caused by these substances in individuals with schizophrenia, in whom the abuse was preceded by the appearance of overt psychotic symptoms.

Development factors

Violent individuals with schizophrenia are more likely to develop than those who do not manifest themselves and those in the general population.

As a result, in childhood and younger adolescence, the former are at a disadvantage. They are more likely to come from disadvantaged with e- Mei, which have been deprived of parental care, they observed growth retardation, there were problems in school and poor peer relationships in childhood and adolescence, criminal histories from family members (Schanda et al , 1992; Tiihonen et al , 1997; Fresan et al , 2004).

Childhood disorder (according to anamnesis), which probably partly reflects the sequence of such factors, is much more often diagnosed in people with schizophrenia who will be violent, and serves as a powerful predictor of such behavior ( Hodgins et al , 2005). Yet such a strong connection seems to be that it uses both ways: individuals with a behavioral disorder and delinquency of juveniles have a history of increased risk of developing schizophrenia in later life ( Gosden et al , 2005).

Box 1. Vulnerabilities that can predispose to violence in schizophrenia

The types of vulnerability that precede the development of active psychopathological symptoms:

• developmental disorders;
• asocial traits of character;
• insufficient education;
• increased frequency of behavior disorder;
• non-socialized delinquency ;
• early onset of substance abuse .

Types of vulnerability acquired due to the active course of the disease:

• active psychopathological symptoms;
• degradation of the individual;
• change in social status;
• substance abuse ;
• unemployment.

Vulnerabilities caused by:

• side effects of drugs, especially akathisia and neuroleptic deficiency syndrome;
• excessive insulation;
• loss of social skills;
• imprisonment.

Current social context

Individuals with schizophrenia often do not form the working skills and social roles of an adult individual even before diagnosing their disorder. Once established, schizophrenia is associated with unemployment, which usually leads to a precarious financial situation and a decline in social status. This usually leads to marginal existence, characterized by poor living conditions, if not homelessness, in socially disorganized neighborhoods where substance abuse, interpersonal conflicts and crimes are common. The risk of violence in individuals with severe mental disorders appears to increase dramatically in those who are discharged from hospital to areas with a high crime rate (Silver, 2000; Logdberg et al, 2004).

Personal factors

Currently, strong evidence has been obtained that personality traits serve as mediating factors for criminal activities in schizophrenia (Moran et al, 2003; Nolan et al, 1999; Moran & Hodgins, 2004; Tengström et al, 2004). In part, the connection is incomprehensible because of the terminology used to describe the weaknesses of the personality of individuals with schizophrenia, unlike those of offenders.

The psychopathic traits of a repeat offender-offender are vividly described as follows: lack of remorse and remorse, search for novelty, impulsivity and heartlessness. On the contrary, to describe the personality disorders observed in schizophrenia, the following expressions are used: flattened affect, lack of empathy, lack of realistic long-term goals, irresponsibility, excessively high self-esteem and hypersensitivity.

In fact, representatives of both groups show irritability, tendency to asocial actions, indifference (or blindness) to the feelings and interests of other people, suspicion and negativity, express ideas of greatness, unrealistic beliefs about their rights and inability to learn from experience. The main thing for the emergence of manifestations of violence are both the type of personality, against which the psychosis manifests, and the negative effects of the schizophrenic process on the person.

Individuals with schizophrenia make a significant contribution to violence in our communities and often destroy their own lives. Approximately 10% of those who will become perpetrators and commit the majority of serious aggressive actions can be identified in advance. A structured program that deliberately influences the criminogenic personality and behavioral factors on the abuse of psychoactive The substance so – you, as well as a change in social status along with active psychopathology disorders, would help prevent violence. Such a system of medical care would significantly reduce the number of violent crimes and cases of murder, reduce the number of schizophrenic patients who are in prison, stop the increase in the number of forensic psychiatric beds and, most importantly, improve the lives of many mentally ill, most troubled people. and disadvantaged.

In this article, I intend to continue the discussion of schizophrenia and violence in order to find out what exactly mediates this connection and, more importantly, how to prevent violence. First, I will provide current data in support of the essential and clinically significant connection between schizophrenia and violence. Then I will review the research on the factors that serve as a link between the presence of schizophrenic syndrome and antisocial behavior. Finally, I will describe possible ways of modifying modern clinical practice and making additional changes to it in order to break the connection between the presence of schizophrenia and aggressive behavior.

Correlations

There is a correlation between the presence of schizophrenic syndrome and more frequent manifestations of antisocial behavior in general and violence in particular ( Hodgins , 1992; Hodgins et al , 1996; Wallace et al , 1998; Angermeyer , 2000; Arsenault et al , 2000; Walsh et al , 2001). Currently, there is a huge amount of evidence that such correlations are significant not only statistically, but also clinically and socially ( Hodgins & Müller-Isberner , 2004).

Why is this connection, if it is so obvious, not widely recognized among doctors and service organizers? Equally puzzling, and why so many researchers and experts in this field (sometimes I) either made it difficult or minimized the significance of correlations in fact to nothing to do with the case?

Research results show that in prisons in all Western countries, 5–10% of people awaiting trial for murder suffer from schizophrenic disorder . The true incidence of schizophrenia among murderers seems to be closer to high swing rates, since almost all studies have systematic errors that underestimate the degree of connection. Taylor and Gunn (1984 a , b ) in their study, which remains one of the most methodologically robust, concluded that 11% of murderers and 9% found guilty of non- lethal violence suffered from schizophrenia. The results of follow-up studies using large samples of people suffering from schizophrenia confirm high rates of violent crime ( Soyka et al , 2004; Wallace et al , 2004; Vevera et al , 2005; Swanson et al , 2006).

On the contrary, doctors may never meet at their reception a patient who committed murder or brutal violence against other people. Up to 10% of murderers suffer from schizophrenia, but the annual risk that a schizophrenic individual will commit a murder is about 1 in 10,000, and the risk that he will be convicted of using violence is one out of 150 ( Wallace et al , 2004). There is an obvious paradox, because the manifestations of extreme aggressiveness, especially the murder, are much less common in our community than most people realize. The annual frequency of homicides in the UK is about 1 per 100,000 population, so even a tenfold increase in risk among individuals with schizophrenia will not necessarily impress the individual doctor, although it will most likely affect society as a whole.

People with schizophrenia often resort to minor verbal abuse and threats of physical violence or try to strike or threaten to do so (5–15% per year), but doctors often do not present this as manifestations of the disease, but as situational, due to personality characteristics or provoked by intoxication. The problems caused by antisocial behavior remain hidden from doctors in the future, because many of those who have committed an offense turn out to be invisible behind prison walls. In prisons, the frequency of schizophrenia is 10 times higher than the average ( Fazel & Danesh , 2002). Hopefully, thanks to the reforms recently carried out in the UK, which will attract outpatient psychiatric teams to prisons, these lost patients will once again be in the field of vision of services.

So, everyday experience tells the doctor one thing, epidemiology is something else. Time to listen to our science – or, as it were, the researchers said in concert, not to mention in unison.

It is more difficult to explain the minimization of the correlation between the presence of schizophrenia and the violence of researchers and scientists, or the rejection of it. This is partly due to good, but inappropriate intentions. Many of us have begun to conduct research in this area, trying to demonstrate that the public’s fear of violence from individuals with mental disorders is not fully justified. To a certain extent, they are exaggerated, but not quite, as it turned out, groundless. The desire to comprehend increased aggressiveness in the appropriate context too often slips unnoticed into denial, reducing its value.

Another problem in evaluating research related to this area is the confusion of fundamental methods. For example, which variables should be corrected before a correlation is calculated between the presence of schizophrenia and violence. Distorting factors create an apparent correlation, establishing a positive, but independent connection with both schizophrenia and aggressive behavior. Mediating factors are a product or consequence of a schizophrenic state that directly or indirectly exacerbates violence.

It may be logical to correct for distorting factors, but amending for mediating factors will weaken or hide statistically significant links. It is not easy to differentiate between distorting and mediating factors in advance. This is partly due to the fact that many factors of interest to us, such as substance abuse , socioeconomic status and even personality traits, can be both distorting and mediating. Therefore, in practice, it is necessary to take a sensible approach to the calculations of the full correlation, and then to ask the question why it exists.