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Insomnia is a problem in human life. It worsens his health throughout the day, contributes to the development of chronic diseases. In relation to children and adults, such a disorder is perceived as a pathology. In older people, it does not seem to be dangerous. And this is wrong.

The percentage of people with sleep disorders after age 65 is steadily increasing. Given the weakened body of the elderly and a predisposition to a number of diseases, disturbed sleep impairs brain function and can become a risk factor for Alzheimer’s disease.

Relatives caring for the older generation often ask themselves the question: “What to do if grandfather or grandmother does not sleep at night?” There is no universal answer and will not be. The way to restore the normal regime depends on the cause and type of insomnia the person has. 

Chronic pathology does not form in a few days. Its development takes place gradually, months and years.

As a rule, sleep problems are caused by a decrease in the production of melatonin, a neurotransmitter responsible for the correct sleep and wakefulness of a person. But for what reason such a disorder arose, it will be necessary to find out.

Sleep disturbances are not accidental, the main causes of insomnia in older people, men and women over 60, are: 

1. Stressful states. The experiences typical of people in years in the evening, before going to bed, often negatively affect the functions of the nervous system.
2. Snoring, nocturnal breathing problems, seizures.
3. Excessive excess weight and a sedentary lifestyle.

1. Bad habits. Alcohol abuse.
2. Lack of sleep hygiene. Incorrect, uncomfortable bed, constant background noise (for example, from a working TV), light, lack of evening ventilation.
3. Chronic diseases affecting the respiratory system or accompanied by pain.
4. Mental and psychological problems. Depression and mental illness should be treated under medical supervision. And the psychological instability, fears about the future, can be dispelled by loved ones.
5. Taking medications that provoke insomnia. In this case, it is necessary to inform the attending physician about the side effect so that he changes the dosage regimen or prescribes another remedy.
6. Little sunlight, vitamin D deficiency. It is recommended to spend more time in the sun or take special medications.

Often, a chronic condition is provoked by several reasons at the same time. For example, high blood pressure with hypertensive encephalopathy and medication that interferes with sleep.  

Types of insomnia in the elderly

To decide what to do if an elderly person does not sleep at night, you need to figure out what form of insomnia developed in old age.

There are three pathology options that are most typical for such patients:

1. Hypersomnia – a person needs a long period of sleep, sleeps 12-20 hours a day. And even after such a long period of rest, the surge of strength and vivacity does not come. The patient wakes up irritated, tired. Hypersomnia is characteristic of people who are constantly exposed to stress and are depressed.
2. Insomnia – difficulty falling asleep or its complete impossibility. Even after a person falls asleep, he cannot rest. Sleep is extremely restless, short, fragmentary, often accompanied by nightmares. As a rule, accumulated stress becomes the cause of the condition. The psychotherapist should think over the treatment regimen.
3. Parasomnia is a sleep phase change disorder. A person wakes up several times during the night, but full awakening does not occur. A similar phenomenon occurs with nocturnal epilepsy, sleepwalking. Requires consultation of a neurologist.

Only by understanding why old elderly people sleep little and poorly can one choose the right treatment. Smart therapy will improve their health and sleep.

Symptoms

In order to determine what to take for insomnia in old age in the elderly and how to get rid of this painful condition, the collection of symptoms plays a significant role at the first visit to the doctor.

The peculiarities of the course of the disease will help to understand what additional examination is required and what treatment will be effective.

Symptoms of insomnia in the elderly:

1. Intermittent difficulty falling asleep. Even in the dark and relaxed state, sleep does not come for hours.
2. More frequent nightmares that cause earlier awakening in an agitated state with a feeling of fear, disgust, regret. In this case, the pulse accelerates, blood pressure often rises.
3. Superficial sleep. Increased sensitivity, frequent awakening at night from the slightest noise, inability to fall asleep after it.
4. A standard 8 hour nap does not bring any rest. The person is haunted by the desire to either sleep longer, or during the day he experiences fatigue and drowsiness.

Each of these signs, which happened once, is not a cause for concern. However, if the patient regularly experiences these symptoms, it is necessary to see a doctor.

Diagnostics

To understand what to do, what treatment to use, it is required to determine the causes of senile insomnia.

The first method that is used to diagnose a patient’s condition is a survey.

The doctor finds out the symptoms of the process, determines the accompanying problems that arise. The person is asked what diseases he has.

Neurological examination is mandatory.

After that, testing is carried out on the Epworth scale. A person is asked to answer questions related to the characteristics of his sleep. Based on the information received, points are assigned and the level of the problem is determined [3]. 

After undergoing preliminary diagnostics, the patient is redirected to instrumental studies, consultations by doctors of a related profile to determine the specific cause of his condition.

Then, when doctors determine why the elderly person is awake at night, they can develop a plan to restore sleep.

Treatment

How to treat insomnia in old age, what methods of combating and preventing such a condition in older people will be effective, should be decided by a professional doctor after a thorough diagnosis. Depending on the results, a therapy regimen will be selected.

For the treatment of sleep disorders, as a secondary symptom of a third-party disease, the root cause, the disease that led to the dyssomnia, is first treated. Having received the result, they begin to get rid of the symptoms.

When the reduction in sleep time is due to age-related changes in the brain, doctors try not to resort to drastic methods, advising preventive measures and mild corrective procedures.

In some cases, insomnia in old age in people, equally, men and women, has reasons that require drug treatment. When prescribing drugs, the doctor is guided by several rules:

• Selection of a drug with suitable pharmacological effects.
• Appointment of small therapeutic doses.
• Short-term courses of drug use (up to 1 month).

• Therapy should be intermittent. You can not use the drug more than 2-3 times a week.
• The gradual withdrawal of hypnotic drugs through dose reduction.
• Close monitoring of the patient’s condition before taking medications and after discontinuation, during follow-up examinations.

When prescribing therapy, it is extremely important to take into account what other medications a person is taking, what chronic diseases he suffers, so as not to worsen the general well-being.

Due to these features, self-medication with hypnotics is highly discouraged [4]. 

Preventing Poor Sleep in Older People

Sleep disorders in old and senile people do not always require complex treatment. Often, the problem, if not resolved, then becomes less acute.

We suggest following a few rules to help you get healthy sleep:

• Monitor the diet, make the evening meal lighter and push back from the time of falling asleep by 2-3 hours.
• Reduce your intake of caffeinated beverages and avoid them in the afternoon.
• Stop drinking alcohol, nicotine and other stimulants.
• Use orthopedic pillows and a mattress for a comfortable and safe sleep.
• Ventilate the bedroom regularly before bed, even during the winter season.

• Introduce more physical activity into the daily regimen, preferably in the second half of the day.
• Reduce TV viewing time in the evenings by taking short walks.

And remember: the question: “How to overcome insomnia in old age?” Is solved individually each time.

Hebephrenic (hebephrenic) schizophrenia or hebephrenia F20.1 is one of the forms of schizophrenia with a continuous and unfavorable course, characterized by inappropriate emotions, silly behavior and torn thinking.        

In 1863 , K. Kahlbaum first identified hebephrenia as an independent form that develops during puberty and is expressed mainly by the phenomena of mental weakness.     

The first detailed descriptions of hebephrenia belong to E. Hecker (1871). In his opinion, in most cases, already from early childhood, a well-known mental weakness, lethargy and reluctance to mental work can be noted .      

The boundaries of hebephrenia have always remained blurred. Even E. Bleuler (1911) considered hebephrenia as a combined group of mental illnesses. According to W. Mayer-Gross (1932), “heboidophrenia” or “heboid” is difficult to distinguish from psychopathies and neuroses. From his point of view, hebephrenia could stop at any stage and even manifest itself in the form of a single decrease in activity.         

According to E. Kraepelin, the course of hebephrenia can be slow, subacute and acute. Many researchers believed that it is continuous and malignant, although structurally, from the point of view of psychopathology, it looks relatively simple.   

R.A. Nadzharov (1972) attributed hebephrenia to a variant of nuclear schizophrenia, in his opinion, with this mental disorder, various, as it were, “compressed in time” and overlapping affective and catatonic symptoms alternate . The initial states of the hebephrenic form of schizophrenia are described in the literature somewhat contradictory. K. Leonhard (1936) described as one of them “silly, eccentric defect of hebephrenia”. According to V.N. Favorina (1964), in the initial state of hebephrenia, catatonic-apathetic states are noted.             

O.V. Kerbikov (1949) singled out a diagnostic triad of symptoms in hebephrenia: “gymnastic contraction of facial muscles”, grimacing; the phenomenon of “inaction of thoughts” (Levi-Valensi A., 1926), accompanied by unmotivated actions; empty, unproductive euphoria. The hebephrenic form of schizophrenia is characterized by an early onset, beginning in adolescence, usually after 10 years.    

According to E. Hecker, the main features of this disease are as follows: mood is characterized by rapid variability and inconstancy; although at the initial stage a depressed, but superficial mood (initial melancholie) prevails. The patient, after crying, fear and fear of persecution, suddenly becomes cheerful and bursts out with some stupid, senseless trick. These transitions are sharp, quick and unexpected: the patients seem to play and flirt with their feelings and mood.          

Signs of hebephrenic schizophrenia

The main signs and features of the hebephrenic form of schizophrenia: 

• early and acute onset; 
• polymorphism of symptoms;
• pronounced disorganization of thinking, speech (meaningless rhymes, verbigeration, incoherence, neologisms) and behavior (foolishness, disorientation, demeanor, grimacing, importunity); 
• inadequacy of emotional reactions (“empty euphoria”);
• infantilism;
• hypersexuality;
• increased appetite;
• malignant and continuous course; 
• resistance to therapy. 

The clinical picture is characterized by a state of excitement, disunity, foolishness, fragmentary, unsystematic, rudimentary delirium and unstable, episodic, simple hallucinations (Hecker E., 1871). According to many psychiatrists, pure hebephrenic form is rare.      

Hallucinatory-delusional inclusions can be sexual, religious, hypochondriacal, and paranoid. Delusional statements are in the nature of something fictional, composed by the patient for fun and tomfoolery (“confabulation”, K. Kahlbaum). In the presence of delusional and, especially, affective disorders, the course of the disease can be paroxysmal and progressive in nature (Polishchuk Yu.I., 1965).    

In the latest classifications, the hebephrenic form of schizophrenia is defined as a disorganized type of schizophrenia with incoherent speech and disorganized behavior.   

The hebephrenic form often begins acutely, manifested by the syndrome of silly excitement and is often combined with euphoria and a kind of childishness.   

Many psychiatrists emphasized that hebephrenia is characterized by a pronounced regression of mental development: primitive and disinhibited behavior; children’s and archaic speech (invectives) with meaningless rhymes and verbigeration.    

Rapidly changing behavior is one of the significant symptoms of hebephrenia, probably reflecting in general the tendency of such patients to erratic activity, to impulsive, impulsive movements, to ridiculous behavior with the character of a feigned prank (Serbsky V.P., 1912).      

With hebephrenia, the patient is often active, but this activity is unfocused, unconstructive. Persistent orders of the patient can be distracted from meaningless behavior, but this usually succeeds for a short time.    

Usually a patient with hebephrenia exhibits increased sexual activity (casual relationships, sexual perversion). For women, it is quite typical to use diminutive – affectionate words, ridiculous coquetry, flirting, manifestations of exhibitionism. 

Emotional reactions are inadequate, fluctuating in their intensity. The mood is usually heightened (“silly fun”), with a tendency to strange and incomprehensible humor, flat jokes. Unreasonable laughter without sufficient reason can be replaced by crying.    

With hebephrenia, thinking and speech are impaired , which may include neologisms, be incoherent, the nature of the statements does not correspond to the experiences. Other formal speech disorders are also characteristic of hebephrenia : incorrect connection of sentences, violation of logical structures. Patients use the same phrases and phrases, resort to a set of pompous and meaningless words.         

Hebephrenic schizophrenia treatment

The primary diagnosis of hebephrenic schizophrenia occurs during puberty. To make an accurate diagnosis, it is necessary to monitor the patient for 2-3 months, paying attention to the presence of characteristic symptoms, on the basis of which it is possible to draw a conclusion about the presence of the disease.        

Treatment for hebephrenic schizophrenia differs significantly from treatment for other types of schizophrenia because this type is characterized by an unfavorable course, taking into account all its manifestations. Thus, only highly qualified specialists can carry out effective treatment.   

Paranoid schizophrenia (F20.0) is a type of schizophrenia characterized by hallucinations and delusions, as well as incoherent speech, affective flattening. There may be mild catatonic symptoms that are not predominant. It is one of the most common types of schizophrenia. A distinctive feature of paranoid schizophrenia is the presence of paraphrenic and paranoid delusions. Catatonic symptoms are mild.          

Causes of paranoid schizophrenia

The main cause of paranoid schizophrenia is brain dysfunctions. Also, genetic factors play a role in the appearance and development of schizophrenia. In addition, the causes of paranoid schizophrenia can be:  

• the presence of viruses in the mother during pregnancy; 
• malnutrition of a pregnant woman;
• stress;
• Alzheimer’s disease;
• the use of psychotropic drugs in adolescence. 

Paranoid schizophrenia can be diagnosed between the ages of twelve and thirty. However, it can often be detected even in infancy.     

Paranoid schizophrenia symptoms

Along with the universal symptoms of schizophrenia, the symptoms of the disease are: 

• delirium of persecution, grandeur, jealousy;
• auditory hallucinations;
• olfactory, gustatory hallucinations, bodily sensations;
• visual hallucinations;
• thinking disorders;
• irritability;
• anger;
• fears;
• suspicion;
• violation of volitional functions.

The course of paranoid schizophrenia

The course of the disease can be episodic, or chronic, in which vivid symptoms persist for several years.

Paranoid schizophrenia usually develops after age 25 . At the first stage, the disease is slow, the initial period can last from 5 to 20 years.      

In the debut, anxiety attacks, obsessive states are observed , then suspicion, isolation, rigidity increase.  

The stage of development of the main clinical manifestations of the disease is characterized by the presence of persecution delusions, physical impact, pseudo-hallucinations.

In the future, there is a hallucinatory-paranoid phenomenon, in some cases hallucinosis prevails, in others – delirium and mixed states. The change of stages is characterized by a wave-like flow.     

Treatment of paranoid schizophrenia

Paranoid schizophrenia can have serious consequences: emotional, behavioral disorders. The patient often becomes depressed, abuses alcohol and drugs.     

The main forms of therapy for paranoid schizophrenia are pharmacological treatment, psychotherapy and electroconvulsive therapy.    

In the treatment of paranoid schizophrenia, alcohol and drugs are categorically contraindicated . 

Approximately 40% of patients with schizophrenia make a suicidal attempt during their lifetime, and in 10-20% it is successful.      

Even if it is possible to stop most of the symptoms of depression in patients with schizophrenia, this does not mean that the threat of suicide has passed. Suicidal thoughts in this disease go away relatively late.     

Among patients with schizophrenia, suicidal attempts are more common in young men, especially if they have tried to commit suicide in the past. Severe symptoms of depression, persistent disorders of perception, panic attacks, and frequent hospitalizations in a psychiatric hospital are considered harbingers of suicidal behavior .   

Suicide risk factors for schizophrenia

• Young age;
• Male;
• History of suicidal attempts ; 
• First psychotic episode;
• Dominance of positive symptoms over negative;
• Significant severity of symptoms of depression;
• Persistent perception disorders (imperative auditory hallucinations);
• Panic attacks;
• Frequent relapses of the disease (frequent hospitalizations);
• The first 3 months after discharge from the hospital;  
• Resistant variants of the course of the disease;
• Autoaggression manifestations;
• Low level of compliance;
• Severe side effects of therapy (akathisia);
• Medicines suspected of increasing the risk of suicide (fluoxetine, duloxetine);
• Inadequate drug therapy (low or high doses of drugs);
• Substance abuse;
• Insufficient social support;
• Stigmatization of the disease;
• Economic problems;
• Relatively high level of intelligence in premorbid. 

The degree of suicide risk is influenced by the level of compliance and the adequacy of drug treatment. Neurological complications of therapy, especially akathisia, may be accompanied by suicidal thoughts .    

Poor social support, stigmatization of the disease, and economic hardship also increase suicidality.

The risk of suicide is higher in patients with a dual diagnosis, when, against the background of the course of schizophrenia, there is a dependence on psychoactive substances.    

Many psychiatrists have noted that suicide in schizophrenia is possible in the early stages of mental disorder, in patients with a relatively high premorbid level of intelligence and with deep feelings about the consequences of the mental disorder.      

The tendency to self-harm, auto-aggressive tendencies, imperative auditory pseudo-hallucinations should alert the doctor to possible suicide.  

In almost 20% of cases, suicidal attempts in schizophrenia occur with its resistant variants of the course (“refractory schizophrenia”) (Heila H. et al., 1999).    

According to psychiatrists, hospitalization partly increases the risk of suicide due to the fact that the patient’s forced isolation from society is perceived by him extremely negatively. At the same time, most psychiatrists consider hospitalization in the presence of suicidal thoughts mandatory, since in this case the patient can be monitored constantly, antidepressants can be prescribed, while providing him with the necessary psychological support (increasing the level of self-esteem, the degree of self-confidence , etc.).           

Suicidal thoughts in schizophrenia can be difficult to recognize, suicidal attempts are difficult to prevent, primarily because of their impulsiveness (Gut-Fayand A. et al., 2001). In addition, unlike other patients with mental disorders, patients with schizophrenia resort to methods of suicide, which practically exclude a failed attempt.         

Analysis of suicide cases in schizophrenia shows that in most cases, at least 3 months before suicide, patients or their relatives sought medical help. In particular, they underwent treatment in a psychiatric hospital, of which almost half of the cases were preceded by a visit to a psychiatrist a week before the suicide (Roy A., 1982). Quite often, the cause of suicide can be the wrong prescription of medications, the intake of inadequate doses of drugs that are either too low or too high.               

Medical personnel involved in the treatment of a person with schizophrenia must be constantly aware of the high risk of suicide in this disease. An open conversation with the patient, a sincere attitude to his experiences, attention to his plans often helps prevent a suicidal attempt.     

Clozapine is considered to be a drug that significantly reduces the likelihood of suicide in schizophrenia, which in this respect is superior not only to traditional antipsychotics, but also to modern atypical antipsychotics, such as olanzapine.    

Schizophrenia is a group of mental disorders characterized by a diverse course, the presence of positive, negative and cognitive symptoms, combined with each other within certain forms.    

The problem of schizophrenia is multifaceted and goes beyond medicine. This mental disorder is not only attracting the attention of doctors, psychologists and social workers, but anthropologists, philosophers, theologians, historians, journalists and people of many other professions are interested in it .        

Writers and artists have repeatedly turned to the topic of schizophrenia, and scientists often looked for traces of genius in the works of those who suffered from this disease.     

Since the moment when the term “schizophrenia” was proposed, the definitions of this concept have often differed among themselves in different countries.  

According to the words of J. Wyrsch (1960), despite the fact that “on the other and the other side of the Rhine authority used as the E. Kraepelin, and E. Bleuler, at one and the same word” schizophrenia “is understood, not one and the same.” It may not have clarified much in twentieth-century psychiatry, but it has often become a stigma that was often mistaken and could cause real harm by violating human rights.                   

It is pertinent to recall that E. Bleuler proposed the term “schizophrenia” just in order to prevent the formation of a negative attitude towards this disease on the part of society. From his point of view, the previous definitions of both “premature dementia” and “intrapsychic ataxia” not only did not correspond to the essence of the disease, but contributed to the mistreatment of people suffering from this disease.          

History knows many examples of the fatal role of many terms in psychiatry. For example, when in 1933 city of in Germany was introduced “Law on prevention of family history of offspring”, the word “schizophrenia” was extremely dangerous.     

In the history of medicine, the importance of schizophrenia can hardly be overestimated. Many terms in psychiatry have developed in parallel with the evolution of the theory of this mental disorder, so the language of modern psychopathology was partly influenced by descriptions of the clinical picture of schizophrenia.    

Some concepts, which were so popular at the time of their appearance, were replaced by others, in the opinion of the researchers, which more accurately corresponded to the essence of the disease. Some terms, such as “premature dementia”, already belong to the pages of history, and the concepts of “procedural”, “psychotic”, “functional psychosis” or “endogenous disease” are recognized as vague, lacking clear criteria.    

And today the meaning of many clinical concepts related to the field of schizophrenia is constantly evolving, gradually adjusting to the requirements of practice and the results obtained in the course of new research.    

The sleep of a schizophrenic patient is usually disturbed. The structure of sleep especially changes before exacerbation or in the process of relapse of the disease. According to S. Dencker et al. (1986), sleep disorder can be considered the most sensitive indicator of an incipient exacerbation of psychosis. The first signs of sleep disorder are manifested by frequent awakenings during the night, “restless sleep.”      

Sometimes the patient does not sleep for several days, and then there is increased drowsiness, which persists for a fairly long period of time. As they recover from psychosis, the patients’ sleep is gradually normalized, but it is not fully restored either by objective indicators or by subjective data.             

To determine the causes of sleep disturbance and increased sleepiness during the day, it is necessary to study the structure of sleep throughout the night (polysomnography).   

Many sleep doctors believe that sleep disturbances in schizophrenia are likely nonspecific and, unlike depression, do not require expensive sleep research.    

Sleep disturbances are most often recorded in those patients with schizophrenia, whose clinical picture is dominated by anxiety-depressive symptoms.  

Especially persistent sleep disorders are observed in patients with a dual diagnosis: schizophrenia and dependence on psychoactive substances.    

Winkelman J. (2001) noted cases of quite frequent occurrence of obstructive sleep apnea in schizophrenic patients. 

According to some authors, sleep disorder in schizophrenia varies in a wide range, however, most often there are disturbances in falling asleep, changes in the 3rd and 4th phases of sleep, especially the contraction of the 4th phase – deep, slow-wave sleep (“slow wave sleep”), changes in the continuity of sleep, and also the reduction of REM – phases (Monti J., Monti D., 2004). Reduction of the 4 sleep phase is of particular diagnostic value for schizophrenia (Feinberg I. et al., 1969; Poulin J. et al., 2003).                  

Sleep disturbances in schizophrenia

1. Falling asleep
2. Sleep disruption
3. Sleep phase 4 reductions ( NREM sleep duration, percentage of NREM sleep) 
4. Dysregulation of REM sleep (decreased REM latency, decreased REM sleep during the night) 
5. Lack of information processing during sleep 

M. Keshavan et al. (1996), proposed to distinguish between variable and invariant sleep parameters in schizophrenia, the former, for example, such as REM sleep parameters (REM – latency and REM density), depended on the mental status of patients, significantly worsening before an exacerbation or during a psychotic episode, on the contrary, the second, in particular, phase 4 , characterizing deep, “slow wave sleep” (duration of slow wave sleep, percentage of slow wave sleep), almost always and regardless of the phase of the disease (prodromal, exacerbation, stabilization, remission) were stably violated in schizophrenia. M. Keshavan et al. (2004) also noted changes in slow-wave sleep in relatives of schizophrenic patients. According to these authors, disturbances in “slow wave sleep” can be an indicator of the danger of developing schizophrenia. It is interesting to note that the proportion of “deep sleep” in young patients shows a negative correlation with the severity of negative symptoms of schizophrenia (Ganguli R., et.al., 1987).                   

For patients with schizophrenia during the period of exacerbation of the disease, it is quite characteristic to disrupt the continuity of sleep, measured by such indicators as: sleep latency, sleep efficiency, awakening time after the onset of sleep, frequency of awakenings per night, total sleep time. From the point of view of B. Hoyt (2005), the continuity of sleep is determined by the state of the dopaminergic system, and the disturbance of the sleep rhythm, in particular, corresponds to its intensification.       

A decrease in REM latency, a decrease in REM sleep density, is especially noticeable during a psychotic episode. Short periods of REM latency are often detected in patients with severe hallucinatory symptoms (Feinberg I. et al., 1965). According to V. Zarcone et.al. (1975), in patients with schizophrenia there is a kind of “selective deprivation of the REM-phase of sleep, i.e. there is a dysregulation of REM sleep, but not a change in its structure.            

Sleep studies in schizophrenic patients show that information processing is impaired during sleep . So, in particular, if light and sound stimuli are used during the night and at the same time the evoked potentials are measured, then in patients with schizophrenia, an enhanced resonance of the response in the theta range can be found (Roschke J. et al., 1998).            

Usually, patients use small doses of clozapine or other antipsychotics to normalize sleep, sometimes they take sleeping pills and tranquilizers. In studies T. Neylan et al. (1992) found that even after the abolition of antipsychotics sleep changes associated with their exposure, may be fixed on for 6 weeks after their cancellation.         

Many researchers associate the directions of further research on somnology in the field of schizophrenia with the use of modern methods of neuroimaging during this period (Gauggel K., 2008).    

Some patients with schizophrenia are treated on an outpatient basis, but neither the patients nor their relatives underestimate the importance of the help of a psychologist and social assistance that the staff of the V.L. One minute to Moscow.

Yes, medications play a critical role in preventing flare-ups of the disease. But it should be constantly monitored and once a month to assess the effects of treatment with psychotropic drugs.

Periodically conducted courses for patients and their relatives – 25-30 sessions with a frequency of twice a week – have a positive effect. After them, the microclimate in the family changes, trust and cooperation with medical personnel, with specialists providing assistance (doctor, psychologist, social worker) is formed. But at the same time, educational courses cannot serve as a reliable means of preventing exacerbations of schizophrenia. 

Cognitive-behavioral therapy allows you to cancel treatment with psychotropic drugs earlier or adjust the dose of medication.

Social skills courses include the formation of household and hygiene habits, training in conflict resolution, time management, self-control and planning skills, and vocational rehabilitation. All this is the path to independent and independent living of the patient.

The complex issues of treatment remain open: when is it necessary to cancel psychotropic drugs, change strong drugs to weak ones, what are the cancellation criteria that allow you to effectively resolve these issues?

In our experience, small doses of classical antipsychotics can have a positive effect on the course of schizophrenia on an outpatient basis.

At this point in time, almost lost interest in the theory of the viral origin of schizophrenia. But this is not due to the fact that scientists have shown its inconsistency. On the contrary , more and more data are accumulating on the large role of viruses, especially herpes group, in the pathogenesis of schizophrenia. And the carriage of the herpes virus by a pregnant woman provokes the development of schizophrenia in her children. According to the clinic V.L. Just a minute, the Epstein-Barr virus also increases the likelihood of schizophrenia. Therefore, when using medicines for the treatment of schizophrenia, it is necessary to take medicines for the treatment of viral infections: 

· Modulators of the immune response;       

· Stabilizers of cellular and humoral responses;       

· Antiviral drugs.       

For such therapy, diagnostic markers of the initiation of antiviral therapy should be determined, for example: cytokines, gliadin , immunoglobulin G, C-reactive protein.

Many psychotropic drugs affect the immune system, which depends on the chemical structure, dose, and duration of the drug intake.

In the clinic of Professor V.L. For a minute, many mental illnesses are being treated in Moscow, including schizophrenia and accompanying sleep disorders in some cases.

In schizophrenia, various sleep disorders are observed, these are:

· Defects in the continuity of sleep;

Falling asleep disorder;

• dysregulation of the REM phase (reduction in the proportion of REM sleep, decrease in the period of REM latency);

· Reduction of the fourth phase of sleep;

· Lack of information processing during sleep.

There are also variable and invariant sleep parameters in schizophrenia. Variable sleep parameters are REM sleep parameters (REM density and REM latency). They depend on the mental status of the patient, worsening before the exacerbation of psychosis, during psychosis. Sleep invariant parameters are the fourth sleep phase (percentage and duration of slow wave sleep). These parameters do not depend on the phase of the disease (prodromal, exacerbation, stabilization, remission). They are found in all patients with schizophrenia.

According to M. Keshavan with colleagues . (1996), impaired slow wave sleep in humans may be a marker of the risk of developing schizophrenia.

With an increase in the negative symptoms of schizophrenia in young patients, the proportion of “deep sleep” also decreases ( Ganguli R. et al ., 1987).

In patients with schizophrenia, during the period of exacerbation of the disease, there is a disruption in the continuity of sleep, which is measured by the following indicators:

• sleep latency;

· Time of awakening;

· Sleep efficiency;

· Frequency of awakening during sleep;

· Total sleep time;

· Frequency of awakening during the night.

Sleep of schizophrenic patients and healthy people is affected by the state of the dopaminergic system; sleep disturbance indicates its activation, which is characteristic during a psychotic episode and hallucinatory symptoms. At the same time, such indicators as REM latency decrease and decrease in REM sleep density ( Hoyt B., 2005, Feinberg I. et al ., 1965).

In patients with schizophrenia, the processing of information during sleep is also impaired. If light and sound stimuli are sent during sleep to patients with schizophrenia during the night, an increase in theta waves can be detected ( Roschke J. et al ., 1998).

To normalize sleep, patients use clonazepine and other antipsychotics, or hypnotics, tranquilizers.

Scientists have found that even after withdrawal of antipsychotics, sleep changes continue for six weeks ( Neylan T. et al . 1992).

Many researchers associate the study of somnology in patients with schizophrenia with the use of neuroimaging methods . This approach is the most productive and optimal, as it allows you to determine the organic cause of schizophrenia and sleep disorders in this disease.

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

The first sign in 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 disturbances, disturbances in the sleep cycle – sleep / wakefulness, etc. Therefore, when psychosis occurs, it is necessary to prescribe drugs that affect the autonomic nervous system.

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

Of course, the appointment of agents, toning the sympathetic nervous system, is to reduce the symptoms of schizophrenia, but at the peak of psychosis set wobble tone and the predominance of the sympathetic nervous system on the parasympathetic with affective-delusional symptomatology, also strengthening the parasympathetic nervous system – with catatonia, which reduces the efficiency simpatomimicheskih drugs and suggests the use of drugs that stimulate the parasympathetic system. It follows from this that the use of sympathicotonics during remission of schizophrenia can take place in order to prevent the recurrence of psychosis. It is known that drugs 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 of 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.