For schizophrenia, the most significant are the peculiar disorders that characterize changes in the patient’s personality. The severity of these changes reflects the malignancy of the disease process. These changes affect all mental properties of the individual. However, the most typical are intellectual and emotional.

Intellectual disorders manifest themselves in various types of thinking disorders: patients complain of an uncontrollable flow of thoughts, their blockage, and parallelism. Schizophrenia is also characterized by symbolic thinking, when the patient explains individual objects and phenomena according to his own meaning that is meaningful only to him. For example, he regards a cherry pit as his loneliness, and an unextinguished cigarette butt as his dying life. Due to a violation of internal inhibition, the patient experiences gluing (agglutination) of concepts.

He loses the ability to distinguish one concept from another. The patient grasps a special meaning in words and sentences; new words appear in speech - neologisms. Thinking is often vague; statements seem to slip from one topic to another without a visible logical connection. Logical inconsistency in statements in a number of patients with far-reaching painful changes takes on the character of speech fragmentation of thinking in the form of “verbal hash” (schizophasia). This occurs as a result of the loss of unity of mental activity.

Emotional disturbances begin with the loss of moral and ethical properties, feelings of affection and compassion for loved ones, and sometimes this is accompanied by hostility and malice. Interest in what you love decreases and eventually disappears completely. Patients become sloppy and do not observe basic hygienic self-care. An essential sign of the disease is also the behavior of patients. An early sign of it may be the appearance of autism: isolation, alienation from loved ones, oddities in behavior (unusual actions, behavior patterns that were previously unusual for the individual and the motives of which cannot be associated with any circumstances). The patient withdraws into himself, into the world of his own painful experiences. The patient’s thinking is based on a perverted reflection of the surrounding reality in the consciousness.

During a conversation with a patient with schizophrenia, when analyzing their letters and writings, in a number of cases it is possible to identify their tendency to reasoning. Reasoning is empty philosophizing, for example, the ethereal reasoning of a patient about the design of an office table, about the expediency of four legs for chairs, etc.

In the early stages of this disease, emotional changes such as depression, guilt, fear, and frequent mood swings may occur. At later stages, a decrease in the emotional background is characteristic, in which it seems that the patient is not able to experience any emotions at all. In the early stages of schizophrenia, depression is a common symptom. The picture of depression can be very clear, long-lasting and observable, or it can be disguised, implicit, the signs of which are visible only to the eye of a specialist.

Emotional and volitional impoverishment develops a certain time after the start of the process and is clearly expressed with an exacerbation of painful symptoms. Initially, the disease may have the character of a dissociation of the patient’s sensory sphere. He can laugh during sad events and cry during joyful ones. This state is replaced by emotional dullness, affective indifference to everything around and especially emotional coldness towards loved ones and relatives.

Emotionally - volitional impoverishment is accompanied by lack of will - abulia. Patients do not care about anything, are not interested in anything, they have no real plans for the future, or they talk about them extremely reluctantly, in monosyllables, without showing any desire to implement them. The events of the surrounding reality hardly attract their attention. They lie indifferently in bed all day long, are not interested in anything, do nothing.

A change in the interpretation of the environment associated with a change in perception is especially noticeable in the initial stages of schizophrenia and, judging by some studies, can be detected in almost two thirds of all patients. These changes can be expressed both in increased perception (which is more common) and in its weakening. Changes related to visual perception are more common. Colors appear more vibrant and shades appear more saturated. The transformation of familiar objects into something else is also noted. Changes in perception distort the outlines of objects, making them threatening. The color shades and structure of the material can seem to transform into each other. The heightened perception is closely related to the overabundance of incoming signals. The point is not that the senses become more receptive, but that the brain, which usually filters out most of the incoming signals, for some reason does not do this. Such a multitude of external signals bombarding the brain makes it difficult for the patient to concentrate and concentrate. According to some reports, more than half of patients with schizophrenia report disturbances in attention and sense of time.

A significant group of symptoms in the diagnosis of early schizophrenia are disorders associated with difficulty or inability to interpret incoming signals from the outside world. Auditory, visual and kinesthetic contacts with the environment cease to be understandable to the patient, forcing him to adapt to the surrounding reality in a new way. This can be reflected both in his speech and in his actions. With such violations, the information received by the patient ceases to be integral for him and very often appears in the form of fragmented, separated elements. For example, when watching television, the patient cannot watch and listen at the same time, and vision and hearing appear to him as two separate entities. The vision of everyday objects and concepts - words, objects, semantic features of what is happening - is disrupted.

Various peculiar senestopathic manifestations are also typical for schizophrenia: unpleasant sensations in the head and other parts of the body. Senestopathies are fanciful in nature: patients complain of a feeling of distension of one hemisphere in the head, dry stomach, etc. The localization of senestopathic manifestations does not correspond to the painful sensations that may occur with somatic diseases.

The strongest impression on others and on the entire culture as a whole, which is expressed even in dozens of works on this topic, is made by the delusions and hallucinations of a patient with schizophrenia. Delusions and hallucinations are the most well-known symptoms of mental illness and, in particular, schizophrenia. Of course, it should be remembered that delusions and hallucinations do not necessarily indicate schizophrenia and schizophrenic nosology. In some cases, these symptoms do not even reflect a general psychotic nosology, being a consequence, for example, of acute poisoning, severe alcohol intoxication and some other painful conditions.

Delirium is a false judgment (inference) that arises without an appropriate reason. It cannot be dissuaded, despite the fact that it contradicts reality and all the previous experience of the sick person. Delusion resists any compelling argument, which is why it differs from simple errors of judgment. According to the content, they distinguish: delusions of grandeur (wealth, special origin, invention, reformation, genius, love), delusions of persecution (poisoning, accusations, robbery, jealousy); delirium of self-abasement (sinfulness, self-blame, illness, destruction of internal organs).

One should also distinguish between unsystematized and systematized delirium. In the first case, we are usually talking about such an acute and intense course of the disease that the patient does not even have time to explain to himself what is happening. In the second, it should be remembered that delusion, having the nature of self-evident for the patient, can be disguised for years under some socially controversial theories and communications. Hallucinations are considered a typical phenomenon in schizophrenia; they complete the spectrum of symptoms based on changes in perception. If illusions are erroneous perceptions of something that really exists, then hallucinations are imaginary perceptions, perceptions without an object.

Hallucinations are one of the forms of impaired perception of the surrounding world. In these cases, perceptions arise without a real stimulus, a real object, have sensory vividness and are indistinguishable from objects that actually exist. There are visual, auditory, olfactory, gustatory and tactile hallucinations. At this time, patients really see, hear, smell, and do not imagine or imagine.

The hallucinating person hears voices that do not exist and sees people (objects, phenomena) that do not exist. At the same time, he has complete confidence in the reality of perception. In cases of schizophrenia, auditory hallucinations are the most common. They are so characteristic of this disease that, based on the fact of their presence, the patient can be given a primary diagnosis of “suspicious schizophrenia.” The appearance of hallucinations indicates a significant severity of mental disorders. Hallucinations, which are very common in psychoses, never occur in patients with neuroses. By observing the dynamics of hallucinosis, it is possible to more accurately determine whether it belongs to one or another nosological form. For example, with alcoholic hallucinosis, “voices” talk about the patient in the third person, and in schizophrenic hallucinosis, they more often turn to him, comment on his actions or order him to do something. It is especially important to pay attention to the fact that the presence of hallucinations can be learned not only from the patient’s stories, but also from his behavior. This may be necessary in cases where the patient hides hallucinations from others.

Another group of symptoms characteristic of many patients with schizophrenia is closely related to delusions and hallucinations. If a healthy person clearly perceives his body, knows exactly where it begins and where it ends, and is well aware of his “I,” then the typical symptoms of schizophrenia are distortion and irrationality of ideas. These ideas in a patient can fluctuate over a very wide range - from minor somatopsychic disorders of self-perception to the complete inability to distinguish oneself from another person or from some other object in the outside world. Impaired perception of oneself and one’s “I” can lead to the patient no longer distinguishing himself from another person. He may begin to believe that he is, in fact, the opposite sex. And what is happening in the outside world can rhyme for the patient with his bodily functions (rain is his urine, etc.).

A change in the patient’s general mental picture of the world inevitably leads to a change in his motor activity. Even if the patient carefully hides the pathological symptoms (the presence of hallucinations, visions, delusional experiences, etc.), it is nevertheless possible to detect the appearance of the disease by its changes in movements, when walking, when manipulating objects and in many other cases. The patient's movement may accelerate or slow down without any apparent reason or more or less clear possibilities to explain it. Feelings of clumsiness and confusion in movements are widespread (often unobservable and, therefore, valuable when the patient himself shares such experiences). The patient may drop things or constantly bump into objects. Sometimes there are short “freezes” while walking or other activity. Spontaneous movements (signaling hands when walking, gesturing) may increase, but more often they acquire a somewhat unnatural character and are restrained, since the patient seems to be very clumsy, and he tries to minimize these manifestations of his awkwardness and clumsiness. Repetitive movements include tremors, sucking movements of the tongue or lips, tics, and ritualistic movement patterns. An extreme variant of movement disorders is the catatonic state of a patient with schizophrenia, when the patient can maintain the same position for hours or even days, being completely immobilized. The catatonic form occurs, as a rule, in those stages of the disease when it was advanced, and the patient did not receive any treatment for one reason or another.

Catatonic syndrome includes states of catatonic stupor and agitation. Catatonic stupor itself can be of two types: lucid And oneiroid.

Lucid catatonia occurs without clouding of consciousness and is expressed by stupor with negativism or numbness or impulsive agitation. Oneiric catatonia includes oneiric stupor, catatonic agitation with confusion, or stupor with waxy flexibility.

At lucid in stupor, the patient retains elementary orientation in the environment and its assessment, while in oneiroid the patient's consciousness is changed. Patients with lucid stupor, after emerging from this state, remember and talk about the events that took place around them during that period. Patients with oneiric conditions report fantastic visions and experiences that they were in the grip of during a stuporous state. Catatonic excitation is senseless, undirected, sometimes taking on a motor character. The patient’s movements are monotonous (stereotypy) and are essentially subcortical hyperkinesis; aggressiveness, impulsive actions, negativism are possible; facial expression often does not correspond to the pose (facial asymmetries may be observed). In severe cases, there is no speech, the excitement is mute, or the patient growls, hums, shouts out individual words, syllables, or pronounces vowels. Some patients exhibit an uncontrollable desire to speak. At the same time, the speech is pretentious, stilted, there are repetitions of the same words (perseveration), fragmentation, and meaningless stringing of one word onto another (verbigeration). Transitions from catatonic excitation to a stuporous state and vice versa are possible.

Hebephrenic syndrome is close to catatonic both in origin and in manifestations. Characterized by excitement with mannerisms, pretentiousness of movements and speech, and foolishness. Fun, antics and jokes do not infect others. Patients tease, grimace, distort words and phrases, tumble, dance, and expose themselves. Transitions between catatonia and hebephrenia are observed.

Changes in the behavior of patients with schizophrenia are usually a reaction to other changes associated with changes in perception, impaired ability to interpret incoming information, hallucinations and delusions, and other symptoms described above. The appearance of such symptoms forces the patient to change the usual patterns and methods of communication, activity, and rest. It should be borne in mind that the patient, as a rule, has absolute confidence in the correctness of his behavior. Absolutely absurd, from the point of view of a healthy person, actions have a logical explanation and conviction that they are right. The patient’s behavior is not a consequence of his incorrect thinking, but a consequence of a mental illness, which today can be quite effectively treated with psychopharmacological drugs and appropriate clinical care.

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Psychological characteristics of a patient with schizophrenia

A change in the interpretation of the environment associated with a change in perception is especially noticeable in the initial stages of schizophrenia and, judging by some studies, can be detected in almost two thirds of all patients. These changes can be expressed both in increased perception (which is more common) and in its weakening. Changes related to visual perception are more common. Colors appear more vibrant and shades appear more saturated. The transformation of familiar objects into something else is also noted. Changes in perception distort the outlines of objects, making them threatening. The color shades and structure of the material can seem to transform into each other. The heightened perception is closely related to the overabundance of incoming signals. The point is not that the senses become more receptive, but that the brain, which usually filters out most of the incoming signals, for some reason does not do this. Such a multitude of external signals bombarding the brain makes it difficult for the patient to concentrate and concentrate. According to some reports, more than half of patients with schizophrenia report disturbances in attention and sense of time.

A significant group of symptoms in the diagnosis of early schizophrenia are disorders associated with difficulty or inability to interpret incoming signals from the outside world. Auditory, visual and kinesthetic contacts with the environment cease to be understandable to the patient, forcing him to adapt to the surrounding reality in a new way. This can be reflected both in his speech and in his actions. With such violations, the information received by the patient ceases to be integral for him and very often appears in the form of fragmented, separated elements. For example, when watching television, the patient cannot watch and listen at the same time, and vision and hearing appear to him as two separate entities. The vision of everyday objects and concepts - words, objects, semantic features of what is happening - is disrupted.

The strongest impression on others and, in general, on the entire culture as a whole, which is expressed even in dozens of works on this topic, is produced by the delusions and hallucinations of a patient with schizophrenia. Delusions and hallucinations are the most well-known symptoms of mental illness and, in particular, schizophrenia. Of course, it should be remembered that delusions and hallucinations do not necessarily indicate schizophrenia and schizophrenic nosology. In some cases, these symptoms do not even reflect general psychotic nosology, being a consequence, for example, of acute poisoning, severe alcohol intoxication and some other painful conditions. However, the appearance of hallucinations and delusions in a person “out of nowhere” can accurately indicate the onset (or active phase) of a mental illness. One should also distinguish between unsystematized and systematized delirium. In the first case, we are usually talking about such an acute and intense course of the disease that the patient does not even have time to explain to himself what is happening. In the second, it should be remembered that delusion, having the nature of self-evident for the patient, can be disguised for years under some socially controversial theories and communications. Hallucinations are considered a typical phenomenon in schizophrenia; they complete the spectrum of symptoms based on changes in perception. If illusions are erroneous perceptions of something that really exists, then hallucinations are imaginary perceptions, perceptions without an object. The hallucinating person hears voices that do not exist and sees people (objects, phenomena) that do not exist. At the same time, he has complete confidence in the reality of perception. In schizophrenia, auditory hallucinations are the most common. They are so characteristic of this disease that, based on the fact of their presence, the patient can be given a primary diagnosis of “suspicious schizophrenia,” which may or may not be confirmed, remaining within the framework of another nosological form. The appearance of hallucinations indicates a significant severity of mental disorders. Hallucinations, which are very common in psychoses, never occur in patients with neuroses. By observing the dynamics of hallucinosis, it is possible to more accurately determine whether it belongs to one or another nosological form. For example, with alcoholic hallucinosis, “voices” talk about the patient in the third person, and in schizophrenic hallucinosis, they more often turn to him, comment on his actions or order him to do something. It is especially important to pay attention to the fact that the presence of hallucinations can be learned not only from the patient’s stories, but also from his behavior. This may be necessary in cases where the patient hides hallucinations from others. Objective signs of hallucinations, which most often reveal the plot of the hallucination in sufficient detail, may indicate a progressive disease.

Another group of symptoms characteristic of many patients with schizophrenia is closely related to delusions and hallucinations. If a healthy person clearly perceives his body, knows exactly where it begins and where it ends, and is well aware of his “I,” then the typical symptoms of schizophrenia are distortion and irrationality of ideas. These ideas in a patient can fluctuate over a very wide range - from minor somatopsychic disorders of self-perception to the complete inability to distinguish oneself from another person or from some other object in the outside world. Impaired perception of oneself and one’s “I” can lead to the patient no longer distinguishing himself from another person. He may begin to believe that he is, in fact, the opposite sex. And what is happening in the outside world can rhyme for the patient with his bodily functions (rain is his urine, etc.).

Changes in emotions are one of the most typical and characteristic changes in schizophrenia. In the early stages of this disease, emotional changes such as depression, guilt, fear, and frequent mood swings may occur. At later stages, a decrease in the emotional background is characteristic, in which it seems that the patient is not able to experience any emotions at all. In the early stages of schizophrenia, depression is a common symptom. The picture of depression can be very clear, long-lasting and observable, or it can be disguised, implicit, the signs of which are visible only to the eye of a specialist. According to some data, up to 80% of patients with schizophrenia exhibit certain episodes of depression, and in half of the patients depression precedes the onset of delusions and hallucinations. In such cases, early diagnosis of schizophrenia is very important, since after the crystallization of delusional states and judgments, the disease passes into a different form, which is more difficult to treat. The patient experiences many unmotivated emotional experiences: guilt, causeless fear, anxiety.

A change in the patient’s general mental picture of the world inevitably leads to a change in his motor activity. Even if the patient carefully hides the pathological symptoms (the presence of hallucinations, visions, delusional experiences, etc.), it is nevertheless possible to detect the appearance of the disease by its changes in movements, when walking, when manipulating objects and in many other cases. The patient's movement may accelerate or slow down without any apparent reason or more or less clear possibilities to explain it. Feelings of clumsiness and confusion in movements are widespread (often unobservable and, therefore, valuable when the patient himself shares such experiences). The patient may drop things or constantly bump into objects. Sometimes there are short “freezes” while walking or other activity. Spontaneous movements (signaling hands when walking, gesturing) may increase, but more often they acquire a somewhat unnatural character and are restrained, since the patient seems to be very clumsy, and he tries to minimize these manifestations of his awkwardness and clumsiness. Repetitive movements include tremors, sucking movements of the tongue or lips, tics, and ritualistic movement patterns. An extreme variant of movement disorders is the catatonic state of a patient with schizophrenia, when the patient can maintain the same position for hours or even days, being completely immobilized. The catatonic form occurs, as a rule, in those stages of the disease when it was advanced, and the patient did not receive any treatment for one reason or another.

Changes in the patient's behavior are usually secondary symptoms of schizophrenia. That is, changes in the behavior of patients with schizophrenia are usually a reaction to other changes associated with changes in perception, impaired ability to interpret incoming information, hallucinations and delusions, and other symptoms described above. The appearance of such symptoms forces the patient to change the usual patterns and methods of communication, activity, and rest. It should be borne in mind that the patient, as a rule, has absolute confidence in the correctness of his behavior. Absolutely absurd, from the point of view of a healthy person, actions have a logical explanation and conviction that they are right. The patient’s behavior is not a consequence of his incorrect thinking, but a consequence of a mental illness, which today can be quite effectively treated with psychopharmacological drugs and appropriate clinical care.

Treatment of schizophrenia

Medicines are the main treatment for schizophrenia. These include such well-known drugs as Halopiridol, Orap, Semap, Triftazin, Tizercin, and others. These drugs help correct strange behavior in patients, but may also cause side effects such as drowsiness, hand tremors, muscle stiffness, or dizziness. To eliminate these side effects, it is necessary to use the drugs Cyclodol and Akineton. Drugs such as Clozapine cause fewer side effects, but regular blood tests are required when taking Clozapine. Recently, new generation drugs have appeared, such as Rispolept, which have a minimal number of side effects, which can significantly improve the quality of life of patients.

Assistive psychotherapy and counseling are often used to help a person with schizophrenia. Psychotherapy helps people with schizophrenia feel better about themselves, especially those who experience irritation and feelings of worthlessness as a result of schizophrenia, and those who tend to deny the presence of this disease. Psychotherapy can equip the patient with ways to deal with everyday problems.

Social rehabilitation is a set of programs aimed at teaching patients with schizophrenia how to maintain independence, both in a hospital setting and at home. Rehabilitation focuses on teaching social skills for interacting with others, skills needed in everyday life such as managing one's finances, cleaning the house, shopping, using public transport, etc., vocational training, which includes activities necessary to obtain and job retention and continuing education for those patients who want to graduate from high school, attend college, or graduate from college. Some patients with schizophrenia successfully obtain higher education.

A day treatment program consists of some form of rehabilitation, usually as part of a program that also includes drug therapy and counseling. Group therapy is aimed at solving personal problems and also allows patients to help each other. In addition, social, recreational and work activities are provided as part of the day programs. The day treatment program may be based in a hospital or mental health center, and some programs provide housing for patients discharged from the hospital

In addition to participating in many activities of the day treatment program, psychosocial rehabilitation centers offer mental health patients membership in a social club. Please remember, however, that these programs do not provide medication or counseling and are not usually affiliated with a hospital or community mental health center. Their main goals are to provide patients with a place where they can feel at home and to teach job skills that prepare social club members to perform specific job responsibilities. Such programs often involve patients living in “collective” houses and apartments.

Conclusion

Most people with schizophrenia are not violent and do not pose a danger to other people. Some patients, however, feel worthless and think that other people treat them badly because they have schizophrenia. It is important that people with schizophrenia understand that they are no worse than other people and follow generally accepted rules for everyday communication with other people.

People with schizophrenia must do everything possible to recover. These are often intelligent and talented people, and even though they have strange thoughts, they should try to do what they have learned before, and also try to acquire new skills. It is important for such patients to participate in treatment and rehabilitation programs, as well as to pursue their professional activities or continue their education to the extent possible.

People with schizophrenia find it difficult to tolerate situations where they are shouted at, irritated, or asked to do something they are unable to do. Family members can help the patient avoid stress by following these guidelines:

Do not yell at the patient or tell him anything that might make him angry. Instead, you need to praise the patient more for good deeds.

Do not argue with the patient or try to deny the existence of strange things that he hears or sees.

Keep in mind that ordinary events - moving to a new place of residence, getting married, or even a holiday dinner - can make people with schizophrenia angry.

Do not become unduly involved in the problems of a sick relative

Show love and respect for the patient. Remember that people with schizophrenia often find themselves in unpleasant situations and sometimes feel bad about themselves because of this illness.

During treatment, symptoms of the disease may appear and disappear. Family members should know what to expect from the patient in terms of doing household chores, working, or socializing with others.

Studies have shown that the majority of patients whose symptoms of schizophrenia were so severe that they had to be hospitalized improved their condition. Many patients may become better than they were at this time, and almost one third of patients may recover and no longer have any symptoms. In groups led by former patients, there are people who once had very severe schizophrenia. Now many of them work, some are married and have their own home. A small part of these people have resumed their studies in colleges, and some have already completed their studies and received good professions. New scientific research is constantly being conducted, and this gives reason to hope that a cure for schizophrenia will be found. Our time is a time of hope for patients with schizophrenia.

References

1. Garrabe J. History of schizophrenia. M., St. Petersburg: B.I., 2000.

2. Psychiatry, Zharikov N.M., Ursova L.G., Khritinin D.F., /M., Medicine, 1989.

3. Guide to Psychiatry, G.V. Morozov, M.: Medicine, 1988.

4. Schizophrenia. Clinic and pathogenesis A. V. Snezhnevsky. M.: Medicine, 1969.

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Schizophrenia is a mental illness of unknown etiology, prone to a chronic course, manifested by typical changes in the patient’s personality and other mental disorders of varying severity, often leading to persistent impairments in social adaptation and ability to work.

With this disease, patients become withdrawn, lose social contacts, and experience a depletion of emotional reactions. At the same time, disturbances of sensations, perception, thinking, and motor-volitional disorders are observed of varying degrees of severity.

Schizophrenia as a separate disease was first identified by the German psychiatrist E. Kraepelin. He took groups of patients who had previously been described with diagnoses of hebephrenia (E. Hecker), catatonia (K. Kahlbaum) and paranoids (V. Magnan), and, following them follow-up, found that in the long-term period they had a kind of dementia. In this regard, E. Kraepelin combined these three groups of painful conditions and called them dementia praecox (dementia praecox). Having identified a separate disease based on the outcome in dementia, E. Kraepelin at the same time allowed for the possibility of recovery. This well-known contradiction in the principle of classification attracted attention and was critically assessed.

Subsequently, the Swiss psychiatrist E. Bleuler (1911) proposed a new term for the name of this disease - “schizophrenia”. E. Bleuler believed that what is most characteristic of this disease is not the outcome of a kind of dementia, but a special dissociation of the mental processes of the individual, its specific change as a result of the disease process. They identified primary and secondary signs of the disease. He considered the primary ones to be the loss of social contacts in patients (autism), impoverishment of emotionality, splitting of the psyche (special thinking disorders, dissociation between various mental manifestations, etc.). All these mental disorders were qualified as personality changes of the schizophrenic type. These changes were of decisive importance in the diagnosis of schizophrenia.

Other mental disorders, defined by E. Bleuler as secondary, additional, are manifested by senesthopathy, illusions and hallucinations, delusions, catatonic disorders, etc. He did not consider these disorders obligatory for schizophrenia, since they also occur in other diseases, although individual of these may be more characteristic of schizophrenia.

Certain forms of schizophrenia have been identified and described. To the three classic forms: hebephrenic, catatonic and paranoid, a fourth form was added - simple. Subsequently, other forms were described: hypochondriacal, periodic, etc. The forms were identified on the basis of the leading syndrome. However, as clinical observations have shown, the psychopathological symptoms typical of one form or another of schizophrenia were not stable. The disease, which manifests itself in the first stages as a simple form, could subsequently exhibit psychopathological signs characteristic of paranoid and other forms.

The psychopathological manifestations of schizophrenia are very diverse. According to their characteristics, they are divided into negative and productive. Negative reflect loss or distortion of productive functions

e – identification of special psychopathological symptoms: hallucinations, delusions, affective tension, etc. Their ratio and representation in the patient’s mental state depend on the progression and form of the disease.

For schizophrenia, as noted, the most significant are the peculiar disorders that characterize changes in the patient’s personality. The severity of these changes reflects the malignancy of the disease process. These changes affect all mental properties of the individual. However, the most typical ones are intellectual and emotional.

I ntellectual disorders manifest themselves in various types of thinking disorders: patients complain of an uncontrollable flow of thoughts, their blockage, parallelism, etc. It is difficult for them to comprehend the meaning of the text they read, books, textbooks, etc. d. There is a tendency to capture special meaning in individual sentences and words, and to create new words (neologisms). Thinking is often vague; statements seem to slip from one topic to another without a visible logical connection. Logical inconsistency in statements in a number of patients with far-reaching painful changes takes on the character of speech discontinuity (schizophasia).

Emotional disturbances begin with the loss of: moral and ethical properties, feelings of affection and compassion for loved ones, and sometimes this is accompanied by hostility and malice. Interest in what you love decreases and eventually disappears completely. Patients become sloppy and do not observe basic hygienic self-care. An essential sign of the disease is also the behavior of patients. An early sign of it may be the emergence of isolation, alienation from loved ones, strangeness in behavior: unusual actions, a manner of behavior that were previously not characteristic of the individual and the motives of which cannot be associated with any circumstances.

Various peculiar senestopathic manifestations are also typical for schizophrenia: unpleasant sensations in the head and other parts of the body. Senestopathies are fanciful in nature: patients complain of a feeling of distension of one hemisphere in the head, dry stomach, etc. The localization of senestopathic manifestations does not correspond to the painful sensations that can occur with somatic diseases.

Perception disorders are manifested mainly by auditory hallucinations and often by various pseudohallucinations of various sense organs: visual, auditory, olfactory, etc. From delusional experiences it is also possible to observe various forms delirium:

paranoid, paranoid and paraphrenic, in the early stages – more often paranoid. Delusions of physical influence are very characteristic of schizophrenia, which is usually combined with pseudohallucinations and is called Kandinsky-Clerambault syndrome by the authors who described it.

Motor-volitional

violations are diverse in their manifestations. They are found in the form of a disorder of voluntary activity and in the form of a pathology of more complex volitional acts. One of the most striking types of disturbance of voluntary activity is catatonic syndrome.

Catatonic syndrome includes states of catatonic stupor and agitation. Catatonic stupor itself can be of two types: lucid and oneiric. With lucid stupor, the patient retains elementary orientation in the environment and its assessment, while with oneiric stupor the patient’s consciousness is altered. Patients with lucid stupor, after emerging from this state, remember and talk about the events that took place around them during that period. Patients with oneiric conditions report fantastic visions and experiences that they were in the grip of during a stuporous state. Stuporous states, as well as catatonic excitations, are complex psychopathological formations, including various symptoms.

More complex volitional acts and volitional processes also undergo various disturbances under the influence of the disease. The most typical is an increasing decrease in volitional activity, ending in apathy and lethargy, and the severity of volitional disorders, as a rule, correlates with the progression of the disease. However, some patients may experience an increase in activity associated with certain painful ideas and attitudes. For example, due to delusional ideas and attitudes, patients are able to overcome exceptional difficulties, show initiative and perseverance, and perform great work. The content of painful experiences of delusional ideas in patients may be different. At the same time, it reflects the spirit of the times, certain socially significant phenomena. Over time, the content of psychopathological manifestations of the disease changes. If in the past evil spirits, religious motives, and witchcraft often appeared in the statements of patients, now new achievements of science and technology.

The question of the prevalence of schizophrenia in the population is an important issue both scientifically and practically. The difficulty in answering this question lies in the fact that it is not yet possible to fully identify these patients among the population. This is primarily due to the lack of reliable data for understanding the essence of schizophrenia and diagnostic criteria for its definition. Available statistical data and the results of epidemiological studies allow us to conclude that its distribution rates are almost identical in all countries and amount to 1–2% of the total population. The initial assumption that schizophrenia is less common in developing countries has not been confirmed. The results of studies specifically conducted in developing countries revealed a similar number of patients with schizophrenia per 1000 population to the number of patients with schizophrenia in European countries. There is only a difference in the representativeness of certain types of clinical manifestations of the disease. Thus, among patients living in developing countries, acute conditions with confusion, catatonic, etc. are more common.

Schizophrenia can begin at any age. However, the most typical age period for the onset of schizophrenia is 20–25 years. At the same time, certain initial clinical manifestations of schizophrenia have their own optimal timing. Thus, schizophrenia with paranoid manifestations begins more often at the age of over 30 years, with neurosis-like symptoms and thinking disorders - in adolescence and young adulthood. In males, the disease begins earlier than in females. In addition, there are differences in the clinical picture of the disease depending on the gender of the patients. In women, the disease is more acute, and various affective pathologies are more common and more pronounced.

• Continuous schizophrenia
• Periodic (recurrent) schizophrenia
• Paroxysmal-progressive schizophrenia

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General characteristics of schizophrenia

Schizophrenia is a disease belonging to the group of endogenous psychoses, since its causes are due to various changes in the functioning of the body, that is, they are not associated with any external factors. This means that the symptoms of schizophrenia do not arise in response to external stimuli (as with neuroses, hysteria, psychological complexes, etc.), but on their own. This is precisely the fundamental difference between schizophrenia and others. mental disorders.

At its core, it is a chronic disease in which a disorder of thinking and perception of any phenomena in the surrounding world develops against the background of a preserved level of intelligence. That is, a person with schizophrenia is not necessarily mentally retarded; his intelligence, like that of all other people, can be low, average, high, and even very high. Moreover, in history there are many examples of brilliant people who suffered from schizophrenia, for example, Bobby Fischer - world chess champion, mathematician John Nash, who received the Nobel Prize, etc. The story of John Nash's life and illness was brilliantly told in the film A Beautiful Mind.

That is, schizophrenia is not dementia or a simple abnormality, but a specific, completely special disorder of thinking and perception. The term “schizophrenia” itself consists of two words: schizo - to split and phrenia - mind, reason. The final translation of the term into Russian may sound like “split consciousness” or “split consciousness.” That is, schizophrenia is when a person has normal memory and intelligence, all his senses (vision, hearing, smell, taste and touch) work correctly, even the brain perceives all information about the environment as needed, but consciousness (cortex brain) processes all this data incorrectly.

For example, human eyes see green leaves of trees. This picture is transmitted to the brain, assimilated by it and transmitted to the cortex, where the process of understanding the information received occurs. As a result, a normal person, having received information about green leaves on a tree, will comprehend it and conclude that the tree is alive, it’s summer outside, there’s shadow under the crown, etc. And with schizophrenia, a person is not able to comprehend information about green leaves on a tree, in accordance with the normal laws characteristic of our world. This means that when he sees green leaves, he will think that someone is painting them, or that this is some kind of signal for aliens, or that he needs to pick them all, etc. Thus, it is obvious that in schizophrenia there is a disorder of consciousness, which is not able to form an objective picture from the available information based on the laws of our world. As a result, a person has a distorted picture of the world, created precisely by his consciousness from the initially correct signals received by the brain from the senses.

It is precisely because of such a specific disorder of consciousness, when a person has knowledge, ideas, and correct information from the senses, but the final conclusion is made with a chaotic use of its functionalities, the disease was called schizophrenia, that is, splitting of consciousness.

Schizophrenia - symptoms and signs

Indicating the signs and symptoms of schizophrenia, we will not just list them, but also explain in detail, including examples, what exactly is meant by this or that formulation, since for a person far from psychiatry, it is the correct understanding of the specific terms used to designate symptoms is the cornerstone for obtaining an adequate understanding of the subject of conversation.

First, you should know that schizophrenia has symptoms and signs. Symptoms mean strictly defined manifestations characteristic of the disease, such as delusions, hallucinations, etc. And signs of schizophrenia are considered to be four areas of human brain activity in which there are disturbances.

Signs of schizophrenia

So, the signs of schizophrenia include the following effects (Bleuler tetrad, four A):

Associative defect – is expressed in the absence of logical thinking in the direction of any final goal of reasoning or dialogue, as well as in the resulting poverty of speech, in which there are no additional, spontaneous components. Currently, this effect is briefly called alogia. Let's look at this effect with an example in order to clearly understand what psychiatrists mean by this term.

So, imagine that a woman is riding on a trolleybus and a friend of hers gets on at one of the stops. A conversation ensues. One of the women asks the other: “Where are you going?” The second one answers: “I want to visit my sister, she’s a little sick, I’m going to visit her.” This is an example of a response from a normal person who does not have schizophrenia. In this case, in the second woman’s response, the phrases “I want to visit my sister” and “she’s a little sick” are examples of additional spontaneous components of speech that were said in accordance with the logic of the discussion. That is, the only answer to the question of where she is going is the “to her sister” part. But the woman, logically thinking through other questions of the discussion, immediately answers why she is going to see her sister (“I want to visit because she is sick”).

If the second woman to whom the question was addressed were schizophrenic, then the dialogue would be as follows:
-Where are you going?
- To my sister.
- For what?
- I want to visit.
- Did something happen to her or just like that?
- It happened.
- What's happened? Something serious?
- I got sick.

Such dialogue with monosyllabic and undeveloped answers is typical for the participants in the discussion, one of whom has schizophrenia. That is, with schizophrenia, a person does not think out the following possible questions in accordance with the logic of the discussion and does not answer them immediately in one sentence, as if ahead of them, but gives monosyllabic answers that require further numerous clarifications.

Autism– is expressed in distraction from the real world around us and immersion in our inner world. A person’s interests are sharply limited, he performs the same actions and does not respond to various stimuli from the surrounding world. In addition, the person does not interact with others and is not able to build normal communication.

Ambivalence – is expressed in the presence of completely opposite opinions, experiences and feelings regarding the same subject or object. For example, with schizophrenia, a person can simultaneously love and hate ice cream, running, etc.

Depending on the nature of ambivalence, three types are distinguished: emotional, volitional and intellectual. Thus, emotional ambivalence is expressed in the simultaneous presence of opposite feelings towards people, events or objects (for example, parents can love and hate children, etc.). Volitional ambivalence is expressed in the presence of endless hesitation when it is necessary to make a choice. Intellectual ambivalence is the presence of diametrically opposed and mutually exclusive ideas.

Affective inadequacy – is expressed in a completely inadequate reaction to various events and actions. For example, when a person sees someone drowning, he laughs, and when he receives some good news, he cries, etc. In general, affect is the external expression of the internal experience of mood. Accordingly, affective disorders are external manifestations that do not correspond to internal sensory experiences (fear, joy, sadness, pain, happiness, etc.), such as: laughter in response to the experience of fear, fun in grief, etc.

These pathological effects are signs of schizophrenia and cause changes in the personality of a person who becomes unsociable, withdrawn, loses interest in objects or events that previously worried him, commits ridiculous acts, etc. In addition, a person may develop new hobbies that were previously completely atypical for him. As a rule, such new hobbies in schizophrenia become philosophical or orthodox religious teachings, fanaticism in following any idea (for example, vegetarianism, etc.). As a result of personality restructuring, a person’s performance and degree of socialization are significantly reduced.

In addition to these signs, there are also symptoms of schizophrenia, which include single manifestations of the disease. The entire set of symptoms of schizophrenia is divided into the following large groups:

• Positive (productive) symptoms;
• Negative (deficient) symptoms;
• Disorganized (cognitive) symptoms;
• Affective (mood) symptoms.

Positive symptoms of schizophrenia

Positive symptoms include symptoms that a healthy person did not previously have and they appeared only with the development of schizophrenia. That is, in this case the word “positive” is not used to mean “good”, but only reflects the fact that something new has appeared. That is, there has been a certain increase in the qualities inherent in man.

Positive symptoms of schizophrenia include the following:

• Rave;
• Hallucinations;
• Illusions;
• State of excitement;
• Inappropriate behavior.

Illusions represent an incorrect vision of a truly existing object. For example, instead of a chair, a person sees a wardrobe, and perceives a shadow on the wall as a person, etc. Illusions should be distinguished from hallucinations, since the latter have fundamentally different characteristics.

Hallucinations are a violation of the perception of surrounding reality using the senses. That is, hallucinations mean certain sensations that do not exist in reality. Depending on which sense organ the hallucinations concern, they are divided into auditory, visual, olfactory, tactile and gustatory. In addition, hallucinations can be simple (individual sounds, noise, phrases, flashes, etc.) or complex (coherent speech, certain scenes, etc.).

The most common are auditory hallucinations, when a person hears voices in his head or in the world around him, sometimes it seems to him that thoughts were not produced by him, but embedded in the brain, etc. Voices and thoughts can give commands, advise something, discuss events, speak vulgarities, make people laugh, etc.

Visual hallucinations develop less frequently and, as a rule, in combination with hallucinations of other types - tactile, gustatory, etc. It is the combination of several types of hallucinations that provides a person with the substrate for their subsequent delusional interpretation. Thus, some unpleasant sensations in the genital area are interpreted as a sign of rape, pregnancy or illness.

It should be understood that for a patient with schizophrenia, his hallucinations are not a figment of the imagination, but he really feels it all. That is, he sees aliens, atmosphere control threads, smells roses from cat litter and other non-existent things.

Rave is a set of certain beliefs, conclusions or conclusions that are completely untrue. Delusions can be independent or provoked by hallucinations. Depending on the nature of the beliefs, delusions of persecution, influence, power, greatness or relationship are distinguished.

The most common delusion of persecution develops, in which a person thinks that someone is chasing him, for example, aliens, parents, children, police, etc. Every small event in the environment seems to be a sign of surveillance, for example, tree branches swaying in the wind are perceived as a sign of observers lying in ambush. The person we meet with glasses is perceived as a liaison who is coming to report on all his movements, etc.

Delusions of influence are also very common and are characterized by the idea that a person is being affected by some kind of negative or positive influence, for example, DNA rearrangement, radiation, suppression of the will by psychotropic weapons, medical experiments, etc. In addition, with this form of delusion, a person is sure that someone controls his internal organs, body and thoughts, putting them directly into his head. However, the delusion of influence may not take such vivid forms, but masquerade as forms quite similar to reality. For example, a person every time gives a piece of cut sausage to a cat or dog, because he is sure that they want to poison him.

Delusion of dysmorphophobia is a persistent belief in the presence of shortcomings that need to be corrected, for example, straightening protruding ribs, etc. The delirium of reformism is the constant invention of some new powerful devices or systems of relationships, which in reality are unviable.

Inappropriate behavior represents either naive stupidity, or strong agitation, or inappropriate manners and appearance for the situation. Typical types of inappropriate behavior include depersonalization and derealization. Depersonalization is a blurring of the boundaries between me and not me, as a result of which one’s own thoughts, internal organs and body parts seem not to be one’s own, but brought from outside, random people are perceived as relatives, etc. Derealization is characterized by an increased perception of any minor details, colors, smells, sounds, etc. Because of this perception, it seems to a person that everything is not happening for real, but that people, like in a theater, play roles.

The most severe type of inappropriate behavior is catatonia, in which a person takes awkward poses or moves erratically. A person in a stupor usually takes awkward poses and holds them for a very long time. Any attempt to change his position is useless, since he puts up resistance that is almost impossible to overcome, because schizophrenics have incredible muscle strength. A special case of awkward postures is waxy flexibility, which is characterized by holding any part of the body in one position for a long time. When excited, a person begins to jump, run, dance and make other meaningless movements.
Also included in the variant of inappropriate behavior is hebephrenia– excessive foolishness, laughter, etc. A person laughs, jumps, laughs and performs other similar actions, regardless of the situation and location.

Negative symptoms of schizophrenia

Negative symptoms of schizophrenia represent previously existing functions that have disappeared or been significantly reduced. That is, before the disease a person had certain qualities, but after the development of schizophrenia they either disappeared or became significantly less pronounced.

In general, negative symptoms of schizophrenia are described as loss of energy and motivation, decreased activity, lack of initiative, poverty of thoughts and speech, physical passivity, emotional poverty and a narrowing of interests. A patient with schizophrenia appears passive, indifferent to what is happening, taciturn, motionless, etc.

However, with a more precise identification of symptoms, the following are considered negative:

• Passivity;
• Loss of will;
• Complete indifference to the outside world (apathy);
• Autism;
• Minimal expression of emotions;
• Flattened affect;
• Slow, sluggish and stingy movements;
• Speech disorders;
• Thinking disorders;
• Inability to make decisions;
• Inability to maintain normal coherent dialogue;
• Low ability to concentrate;
• Rapid depletion;
• Lack of motivation and lack of initiative;
• Mood swings;
• Difficulty in constructing an algorithm for sequential actions;
• Difficulty finding a solution to a problem;
• Poor self-control;
• Difficulty switching from one type of activity to another;
• Ahedonism (inability to experience pleasure).

Due to lack of motivation, schizophrenics often stop leaving the house, do not perform hygienic procedures (do not brush their teeth, do not wash, do not take care of their clothes, etc.), as a result of which they acquire a neglected, sloppy and repulsive appearance.

The speech of a person suffering from schizophrenia is characterized by the following features:

• Constantly jumping on different topics;
• The use of new, invented words that are understandable only to the person himself;
• Repeating words, phrases or sentences;
• Rhyming – speaking in meaningless rhyming words;
• Incomplete or abrupt answers to questions;
• Unexpected silences due to blockage of thoughts (sperrung);
• An influx of thoughts (mentism), expressed in rapid, incoherent speech.

Autism represents a person’s separation from the world around him and immersion in his own little world. In this state, the schizophrenic seeks to avoid contact with other people and live alone.

Various disorders of will, motivation, initiative, memory and attention are generally called depletion of energy potential , because a person gets tired quickly, cannot perceive new things, poorly analyzes the totality of events, etc. All this leads to a sharp decrease in the productivity of his activities, as a result of which, as a rule, he loses his ability to work. In some cases, a person develops an extremely valuable idea, which consists in the need to preserve strength, and which manifests itself in a very careful attitude towards one’s own person.

Emotions in schizophrenia become weakly expressed, and their spectrum is very poor, which is usually called flattened affect . First, the person loses responsiveness, compassion and the ability to empathize, as a result of which the schizophrenic becomes selfish, indifferent and cruel. In response to various life situations, a person can react in a completely atypical and incongruous manner, for example, be absolutely indifferent to the death of a child or be offended by an insignificant action, word, look, etc. Very often a person can experience deep affection and submit to one close person.

As schizophrenia progresses, flattened affect can take on unique forms. For example, a person can become eccentric, explosive, unrestrained, conflictual, angry and aggressive, or, on the contrary, acquire complacency, euphoric high spirits, stupidity, uncriticality of actions, etc. With any variant of flattened affect, a person becomes sloppy and prone to gluttony and masturbation.

Thinking disorders are manifested by illogical reasoning and incorrect interpretation of everyday things. Descriptions and reasoning are characterized by so-called symbolism, in which real concepts are replaced by completely different ones. However, in the understanding of patients with schizophrenia, it is precisely these concepts that do not correspond to reality that are symbols of certain real things. For example, a person walks naked, but he explains it this way: nakedness is needed to remove a person’s stupid thoughts. That is, in his thinking and consciousness, nudity is a symbol of liberation from stupid thoughts.

A special variant of thinking disorder is reasoning, which consists of constant empty reasoning on abstract topics. Moreover, the final goal of the reasoning is completely absent, which makes it meaningless. In severe cases, schizophrenia may develop schizophasia, which is the utterance of unrelated words. Patients often combine these words into sentences, observing the correctness of cases, but they do not have any lexical (semantic) connection.

With a predominance of suppressed will in the negative symptoms, a schizophrenic easily falls under the influence of various sects, criminal groups, asocial elements, obeying their leaders unquestioningly. However, a person may retain a will that allows him to perform some meaningless action to the detriment of normal work and social interaction. For example, a schizophrenic can draw up a detailed plan of a cemetery with the designation of each grave, count the number of any letters in a particular literary work, etc.

Agedonia represents the loss of the ability to enjoy anything. Thus, a person cannot eat with pleasure, walk in the park, etc. That is, against the background of anhedonia, a schizophrenic, in principle, cannot receive pleasure even from those actions, objects or events that previously gave him pleasure.

Disorganized symptoms

Disorganized symptoms are a special case of productive symptoms because they include chaotic speech, thinking and behavior.

Affective symptoms

Affective symptoms represent various options for lowering mood, for example, depression, suicidal thoughts, self-blame, self-flagellation, etc.

Typical syndromes characteristic of schizophrenia

These syndromes are formed only from positive or negative symptoms, and represent the most common combinations of manifestations of schizophrenia. In other words, each syndrome is a collection of the most frequently combined individual symptoms.

So, Typical positive syndromes of schizophrenia include the following:

• Hallucinatory-paranoid syndrome – characterized by a combination of unsystematized delusional ideas (most often persecution), verbal hallucinations and mental automatism (repetitive actions, the feeling that someone is controlling thoughts and parts of the body, that everything is not real, etc.). All symptoms are perceived by the patient as something real. There is no feeling of artificiality of feelings.
• Kandinsky-Clerambault syndrome – refers to a type of hallucinatory-paranoid syndrome and is characterized by the feeling that all visions and disorders of a person are violent, that someone created them for him (for example, aliens, Gods, etc.). That is, it seems to a person that they are putting thoughts into his head and controlling his internal organs, actions, words and other things. Episodes of mentalism (influx of thoughts) occur periodically, alternating with periods of withdrawal of thoughts. As a rule, there is a completely systematized delusion of persecution and influence, in which a person explains with complete conviction why he was chosen, what they want to do to him, etc. A schizophrenic with Kandinsky-Clerambault syndrome believes that he does not control himself, but is a puppet in the hands of persecutors and evil forces.
• Paraphrenic syndrome – characterized by a combination of persecutory delusions, hallucinations, affective disorders and Kandinsky-Clerambault syndrome. Along with ideas about persecution, a person has a clear conviction of his own power and control over the world, as a result of which he considers himself the ruler of all Gods, the Solar system, etc. Under the influence of his own delusional ideas, a person can tell others that he will create paradise, change the climate, transfer humanity to another planet, etc. The schizophrenic himself feels himself in the center of grandiose, allegedly occurring events. Affective disorder consists of a constantly elevated mood up to a manic state.
• Capgras syndrome- characterized by the delusional idea that people can change their appearance to achieve certain goals.
• Affective-paranoid syndrome – characterized by depression, delusional ideas of persecution, self-accusation and hallucinations with a strong accusatory character. In addition, this syndrome may be characterized by a combination of delusions of grandeur, noble birth and hallucinations of a laudatory, glorifying and approving nature.
• Catatonic syndrome – characterized by freezing in a certain position (catalepsy), giving parts of the body some uncomfortable position and maintaining it for a long time (waxy mobility), as well as strong resistance to any attempts to change the adopted position. Mutism may also be observed - muteness with intact speech apparatus. Any external factors, such as cold, humidity, hunger, thirst and others, cannot force a person to change the absent facial expression with almost completely absent facial expressions. In contrast to freezing in a certain position, agitation may appear, characterized by impulsive, senseless, pretentious and mannered movements.
• Hebephrenic syndrome – characterized by goofy behavior, laughter, mannerisms, grimacing, lisping, impulsive actions and paradoxical emotional reactions. A combination with hallucinatory-paranoid and catatonic syndromes is possible.
• Depersonalization-derealization syndrome – characterized by painful and extremely unpleasant feelings about changes in one’s own personality and the behavior of the surrounding world, which the patient cannot explain.

Typical negative syndromes of schizophrenia are the following:

• Thought disorder syndrome – manifests itself in diversity, fragmentation, symbolism, blockage of thinking and reasoning. Diversity of thinking is manifested by the fact that insignificant features of things and events are perceived by a person as the most important. The speech is detailed with a description of details, but vague and unclear regarding the general main idea of ​​the patient’s monologue. Disruption of speech is manifested by the fact that a person constructs sentences from words and phrases unrelated in meaning, which, however, are grammatically connected by the correct cases, prepositions, etc. A person cannot complete a thought because he constantly deviates from the given topic by association, jumps to other topics, or begins to compare something incomparable. In severe cases, fragmented thinking is manifested by a stream of unrelated words (verbal hash). Symbolism is the use of a term as a symbolic designation for an entirely different concept, thing, or event. For example, with the word stool, the patient symbolically designates his legs, etc. Blocked thinking is a sudden break in the thread of thought or loss of the topic of conversation. In speech, this is manifested by the fact that a person begins to say something, but abruptly falls silent, without even finishing the sentence or phrase. Reasoning is sterile, lengthy, meaningless, but numerous reasoning. In speech, a person with schizophrenia may use their own made-up words.
• Emotional disturbance syndrome – characterized by fading reactions and coldness, as well as the appearance of ambivalence. People lose emotional connections with loved ones, losing compassion, pity and other similar manifestations, becoming cold, cruel and insensitive. Gradually, as the disease progresses, emotions disappear completely. However, it is not always the case that a patient with schizophrenia who does not show emotions is completely absent. In some cases, a person has a rich emotional spectrum and is extremely burdened by the fact that he is not able to fully express it. Ambivalence is the simultaneous presence of opposite thoughts and emotions in relation to the same object. The consequence of ambivalence is the inability to make a final decision and make a choice from possible options.
• Disorder of will syndrome (abulia or hypobulia) – characterized by apathy, lethargy and lack of energy. Such disorders of the will cause a person to isolate himself from the outside world and withdraw into himself. With strong violations of the will, a person becomes passive, indifferent, lacking initiative, etc. Most often, disorders of the will are combined with those in the emotional sphere, so they are often combined into one group and called emotional-volitional disorders. For each individual person, the clinical picture of schizophrenia may be dominated by volitional or emotional disturbances.
• Personality change syndrome is the result of the progression and deepening of all negative symptoms. A person becomes mannered, ridiculous, cold, withdrawn, uncommunicative and paradoxical.

Symptoms of schizophrenia in men, women, children and adolescents

Schizophrenia at any age in both sexes manifests itself with exactly the same symptoms and syndromes, without actually having any significant features. The only thing that needs to be taken into account when determining the symptoms of schizophrenia is age norms and the characteristics of people’s thinking.

The first symptoms of schizophrenia (initial, early)

Schizophrenia usually develops gradually, that is, some symptoms appear first, and then they intensify and are complemented by others. The initial manifestations of schizophrenia are called symptoms of the first group, which include the following:

• Speech disorders. As a rule, a person begins to answer any questions in monosyllables, even those that require a detailed answer. In other cases, it cannot comprehensively answer the question posed. It is rare that a person is able to answer a question in full detail, but he speaks slowly.
• Agedonia– inability to enjoy any activities that previously fascinated the person. For example, before the onset of schizophrenia, a person loved to embroider, but after the onset of the disease, this activity does not interest him at all and does not give him pleasure.
• Weak expression or complete absence of emotions. The person does not look into the eyes of the interlocutor, the face is expressionless, no emotions or feelings are reflected on it.
• Inability to complete any task , because a person does not see the meaning in it. For example, a schizophrenic does not brush his teeth because he does not see the point in doing so, because they will get dirty again, etc.
• Poor concentration on any subject.

Symptoms of different types of schizophrenia

Currently, based on the syndromes that predominate in the clinical picture, according to international classifications, the following types of schizophrenia are distinguished:
1. Paranoid schizophrenia;
2. Catatonic schizophrenia;
3. Hebephrenic (disorganized) schizophrenia;
4. Undifferentiated schizophrenia;
5. Residual schizophrenia;
6. Post-schizophrenic depression;
7. Simple (mild) schizophrenia.

Paranoid (paranoid) schizophrenia

The person has delusions and hallucinations, but normal thinking and adequate behavior remain. The emotional sphere also does not suffer at the beginning of the disease. Delusions and hallucinations form paranoid, paraphrenic syndromes, as well as Kandinsky-Clerambault syndrome. At the onset of the disease, delirium is systemic, but as schizophrenia progresses, it becomes fragmentary and incoherent. Also, as the disease progresses, a syndrome of emotional-volitional disorders appears.

Catatonic schizophrenia

The clinical picture is dominated by disturbances in movement and behavior, which are combined with hallucinations and delusions. If schizophrenia occurs in attacks, then catatonic disorders are combined with oneiroid(a special state in which a person, based on vivid hallucinations, experiences battles of the titans, intergalactic flights, etc.).

Hebephrenic schizophrenia

The clinical picture is dominated by thinking disorders and emotional disorders syndrome. A person becomes fussy, foolish, mannered, talkative, prone to reasoning, his mood constantly changes. Hallucinations and delusions are rare and absurd.

Simple (mild) schizophrenia

Negative symptoms predominate, and episodes of hallucinations and delusions are relatively rare. Schizophrenia begins with a loss of vital interests, as a result of which a person does not strive for anything, but simply wanders aimlessly and idly. As the disease progresses, activity decreases, apathy develops, emotions are lost, and speech becomes poor. Productivity at work or school decreases to zero. There are very few or no hallucinations and delusions.

Undifferentiated schizophrenia

Undifferentiated schizophrenia is characterized by a combined manifestation of symptoms of paranoid, hebephrenic and catatonic types of the disease.

Residual schizophrenia

Residual schizophrenia is characterized by the presence of slightly pronounced positive syndromes.

Postschizophrenic depression

Post-schizophrenic depression is an episode of illness that occurs after a person has recovered from the disease.

In addition to the above, some doctors additionally distinguish manic schizophrenia.

Manic schizophrenia (manic-depressive psychosis)

The main clinical picture is obsessions and delusions of persecution. Speech becomes verbose and profuse, as a result of which a person can talk for hours about literally everything that surrounds him. Thinking becomes associative, as a result of which unrealistic relationships arise between the objects of speech and analysis. In general, at present there is no manic form of schizophrenia, since it was isolated into a separate disease - manic-depressive psychosis.

Depending on the nature of the course, continuous and paroxysmal-progressive forms of schizophrenia are distinguished. In addition, in modern Russia and the former USSR, recurrent and sluggish types of schizophrenia were also distinguished, which in modern classifications correspond to the terms schizoaffective and schizotypal disorder. Let us consider the symptoms of acute (stage of psychosis of paroxysmal-progressive form), continuous and sluggish schizophrenia.

Acute schizophrenia (attacks of schizophrenia) - symptoms

The term acute usually refers to the period of attack (psychosis) of paroxysmal-progressive schizophrenia. In general, as the name implies, this type of schizophrenia is characterized by alternating acute attacks and periods of remission. Moreover, each subsequent attack is more severe than the previous one, and after it there are irreversible consequences in the form of negative symptoms. The severity of symptoms also increases from one attack to another, and the duration of remissions is reduced. In incomplete remission, a person is haunted by anxiety, suspicion, delusional interpretation of any actions of people around him, including relatives and friends, and is also bothered by periodic hallucinations.

An attack of acute schizophrenia can occur in the form of psychosis or oneiroid. Psychosis is characterized by vivid hallucinations and delusions, complete detachment from reality, delusions of persecution, or depressive detachment and self-absorption. Any fluctuations in mood cause changes in the nature of hallucinations and delusions.

Oneiroid is characterized by unlimited and very vivid hallucinations and delusions that concern not only the world around us, but also oneself. Thus, a person imagines himself as some other object, for example, pockets, a disc player, a dinosaur, a car fighting with people, etc. That is, a person experiences complete depersonalization and derealization. At the same time, within the framework of the delusional-illusory idea of ​​oneself as someone or something that has arisen in the head, entire scenes from the life or activity of that with which the person identified himself are played out. The experienced images cause motor activity, which can be excessive or, on the contrary, catatonic.

Continuous schizophrenia

Continuous schizophrenia is characterized by a slow and constant progression of the severity of negative symptoms, which are constantly recorded without periods of remission. As the disease progresses, the brightness and severity of the positive symptoms of schizophrenia decreases, but the negative ones become increasingly stronger.

Sluggish (latent) schizophrenia

This type of course of schizophrenia has many different names, such as mild, non-psychotic, microprocessual, rudimentary, sanatorium, prephase, slow-flowing, hidden, larved, amortized, pseudoneurotic, occult, non-regressive. The disease is not progressive, that is, over time, the severity of symptoms and personality degradation do not increase. The clinical picture of sluggish schizophrenia differs significantly from all other types of the disease, since it lacks delusions and hallucinations, but contains neurotic disorders, asthenia, depersonalization and derealization.

Sluggish schizophrenia has the following stages:

• Debut– proceeds unnoticed, as a rule, at puberty;
• Manifest period – characterized by clinical manifestations, the intensity of which never reaches the level of psychosis with delusions and hallucinations;
• Stabilization– complete elimination of manifest symptoms for a long period of time.

The symptoms of the manifest of sluggish schizophrenia can be very variable, since they can occur according to the type of asthenia, obsessive-compulsive neurosis, hysteria, hypochondria, paranoia, etc. However, with any variant of the manifesto of low-grade schizophrenia, a person has one or two of the following defects:
1. Verschreuben- a defect expressed in odd behavior, eccentricities and eccentricity. The person makes uncoordinated, angular movements, similar to those of a child, with a very serious expression on his face. The person's general appearance is sloppy, and his clothes are completely awkward, pretentious and ridiculous, for example, shorts and a fur coat, etc. The speech is equipped with unusual turns of phrase and is replete with descriptions of minor minor details and nuances. Productivity of physical and mental activity is preserved, that is, a person can work or study, despite eccentricity.
2. Pseudopsychopathization - a defect expressed in a huge number of super-valuable ideas with which a person literally gushes. At the same time, the individual is emotionally charged, he is interested in everyone around him, whom he is trying to attract for the implementation of countless extremely valuable ideas. However, the result of such vigorous activity is insignificant or completely absent, therefore the productivity of the individual’s activity is zero.
3. Defect in energy potential reduction – expressed in the passivity of a person who is mostly at home, not wanting to do anything.

Neurosis-like schizophrenia

This type belongs to sluggish schizophrenia with neurosis-like manifestations. A person is bothered by obsessions, but he is not emotionally charged to carry them out, so he has hypochondria. Obsessions last a long time.

Alcoholic schizophrenia - symptoms

Alcoholic schizophrenia does not exist as such, but alcohol abuse can trigger the development of the disease. The state in which people find themselves after prolonged drinking is called alcoholic psychosis and has nothing to do with schizophrenia. But due to pronounced inappropriate behavior, disorders of thinking and speech, people call this condition alcoholic schizophrenia, since everyone knows the name of this particular disease and its general essence.

Alcoholic psychosis can occur in three ways:

• Delirium (delirium tremens) – occurs after stopping the consumption of alcoholic beverages and is expressed in the fact that a person sees devils, animals, insects and other objects or living beings. In addition, the person does not understand where he is and what is happening to him.
• Hallucinosis- Occurs during heavy drinking. The person is bothered by auditory hallucinations of a threatening or accusing nature.
• Delusional psychosis– occurs with prolonged, regular and fairly moderate consumption of alcohol. It is expressed by delusions of jealousy with persecution, attempts at poisoning, etc.

Symptoms of hebephrenic, paranoid, catatonic and other types of schizophrenia - video

Schizophrenia: causes and predisposing factors, signs, symptoms and manifestations of the disease - video

Causes and symptoms of schizophrenia - video

Signs of schizophrenia (how to recognize the disease, diagnosis of schizophrenia) - video

Post-traumatic syndrome or post-traumatic stress disorder (PTSD) - causes, symptoms, diagnosis, treatment and rehabilitation

The table shows a comparison between the two groups of patients by age (at the time of examination) and some social indicators. reflecting the picture of social adaptation of patients, as well as the duration and degree of malignancy of the course of the schizophrenic process.

As can be seen from the table, there was no significant difference in the age of patients between the two groups (average age within 32-33 years).

A different picture is observed when comparing social indicators. Thus, almost half of the patients in the second (control) group had families and, despite their relatively young age, most of them (80%) received secondary and higher education. At the same time, more than half (52%) of the patients were not working or studying at the time of the examination. In this regard, we can talk about their rapid social disadaptation. The large proportion (56%) of people with disabilities due to mental illness confirms this.

Other social indicators characterize patients in the main group. Most of them did not have a family and acquired only primary education (17 and 15 people, respectively, i.e. 68 and 60%). However, the number of patients employed at work is relatively high (68% worked or studied). At the same time, the vast majority of patients (23 out of 25) did not have disabilities and only one was a disabled person of the second group due to mental illness.

Thus, when comparing the two groups of patients, the difference in social indicators attracts attention. It should be noted that a lower educational level and worse family adaptation among patients with schizophrenia who committed socially dangerous acts were found in epidemiological studies by N.M. Zharikov et al. (1965) and V.M. Shumakov (1974). However, statistical analysis does not provide a clear explanation for this fact. There is an assumption that the difference in the level of social adaptation is associated with features in the clinical picture of schizophrenia. When analyzing clinical features, first of all, differences in the degree of progression of the schizophrenic process and the duration of the disease are revealed.

Thus, in patients in the control group, the disease began on average at the age of 22-23 years. Apparently, this circumstance is associated with the relatively higher educational level of these patients and the possibility of better family adaptation. At the same time, the rate of development of the process was in most cases fast and moderately progressive (92%). These data, in comparison with the average duration of illness in this group at the time of the examination (10.5 years) and the rate of disability (14 disabled people due to mental illness, of which 12 disabled people of groups 1 and 2) indicate a significant severity of the schizophrenic process.

In the clinical picture of the disease in patients in the control group, there were psychopathological features characteristic of malignant types of schizophrenia.

The structure of the paranoid syndrome was dominated by polythematic delusional ideas, accompanied, as a rule, by pronounced affective fluctuations and abnormal behavior of patients. The latter contributed to the timely detection of mental illness and hospitalization.

The delusional syndrome in these patients had the character of a widespread and vague delusion of persecution. Usually delusional ideas were non-specific. The patients suspected that “someone was harming” them, “being persecuted, but no one knows who,” and stated that they felt “some kind of influence.” In most cases, there was no persistence of the delusional theme. Paranoid ideas of various contents quickly replaced one another. The polythematic nature and frequent change of one topic of delirium to another led to the fact that delirium, while always remaining leading in the clinical picture of the disease, was not of significant relevance for the patient. At the same time, his behavior, although often caused by delusional experiences, was, on the one hand, very changeable, unfocused, and on the other, so unusual that it led to the emergency intervention of psychiatrists and placement in a psychiatric hospital.

It should be emphasized that delusional syndrome usually occurred during exacerbations of the condition and was accompanied by affective disorders.

As an example, we cite one of the exacerbations of the schizophrenic process in patient K., who, while at home, became excitable, angry, sometimes incoherently shouted out individual words, exposed himself, and tore his clothes. On the 3rd day of this state, he suddenly announced that his wife was “connected with fascist intelligence,” cut the telephone cord and locked himself in his room. Upon the doctor’s arrival, he willingly went to the hospital, declaring that “it’s dangerous at home.” In the psychiatric ward, the patient refused to eat, declaring that the medical workers wanted to poison him, but he willingly took food from the hands of his wife who was visiting him.

This observation reveals, first of all, a significant severity of the condition, accompanied by changes in efficiency, individual catatonic inclusions, fragmentary delusions of persecution with an ambient attitude towards the object of the delusional theme (the wife - the “persecutor”). The ease of the patient’s consent to hospitalization is noteworthy, reminiscent of the pathological motivation of behavior of the “delusional defense” type (II. Shipkovensky, 1973).

In other cases, it was also possible to talk about polymorphism of psychopathological symptoms. At the same time, psychopathological phenomena, including the leading delusional syndrome, bore the features of either a significant severity of the condition, or were combined with defects-symptoms, and the clinical picture approached the “major syndrome” according to A.V. Snezhnevsky with his characteristic mosaic of symptoms. Thus, in the structure of the paranoid syndrome, delusional ideas were combined with body dysmorphic disorders, elements of Kandinsky syndrome, false recognition, catatonic symptoms, and sometimes even elements of oneiroid were observed.

On the other hand, this group of observations was characterized by the rapid formation of a schizophrenic personality defect. Lethargy, aspontaneity, ambivalence, and intellectual impairment sometimes deprived patients of the ability to engage in purposeful aggressive delusional behavior, even in cases where specific individuals were included in the delirium (in our observations, these were the patient’s relatives or medical workers in psychiatric institutions). Thus, patient S. believed that the local psychiatrist “treats him badly.” However, when the doctor visited him at home, he passively submitted to the examination, since he was “too lazy to object.”

Several observations from this group noted that dangerous actions were directed toward oneself. Thus, one patient, fearing poisoning, starved himself to the point of exhaustion. Another, convinced that others considered him “bad,” made several suicide attempts.

Thus, we can say that the common characteristic features were, on the one hand, the rapid growth of the schizophrenic defect, which by the time the delusional syndrome appeared had already reached significant depth, and, on the other hand, the vagueness, vagueness of the paranoid syndrome and the lack of specificity of delusional ideas.

Other clinical features were observed in patients of the main group who committed socially dangerous actions.

First of all, the duration of their disease was significantly longer (14.2 years), and the rate of development was generally slower (32% of patients with a low degree of progression compared to 8% in group 2). Thus, taking into account the equality of age of patients in the two groups, it is clear that in group 1 schizophrenia began earlier, which apparently explains the lack of education. At the same time, the slow development of the disease allowed patients to stay alive longer and maintain their ability to work. This is confirmed by indicators of labor force participation and disability.

However, the most significant clinical difference between patients of the 1st and 2nd groups was that the delusional ideas that arose during the slow, long-term development of the disease were specific, monothematic, aimed at certain individuals, clearly defined and, as a rule, very relevant for the sick. Systematized delusions of persecution often developed over the years, gradually subjugating all the patient’s activities. At the same time, defective symptoms appeared relatively late, which allowed patients to successfully hide and dissimulate painful experiences and maintain relatively correct behavior for a long time. Long-term preservation of outwardly correct behavior with significant relevance of delusional experiences and their specificity allowed patients to secretly prepare for “defense” from imaginary persecutors or for “revenge” on them. Characteristic of some of these patients was the outward deliberation of a socially dangerous act.

Thus, patient B. married the “stalker,” with the goal of dealing with her. For several years he secretly prepared for “revenge” and then killed his wife. Patient O., while studying at school, was convinced that the teachers treated him badly and persecuted him, but for many years he hid this; 5 years after graduating from school, he set it on fire “out of revenge” on the teachers.

These observations indicate a particular danger of long-term delusional syndrome in patients with relatively slow development of defective symptoms. It should be emphasized that the commission of dangerous actions in most cases was preceded by an increase in affective tension. Moreover, unlike the control group, it was due to an exacerbation of paranoid symptoms and the actualization of delusional ideas. In the structure of the paranoid syndrome, in addition to affectively rich delusional ideas of specific content, other psychopathological symptoms were observed extremely rarely. The clinical “harmony” of the delusional syndrome was therefore not “disturbed” by anything and conditions did not arise, as in patients of the 2nd group, to a decrease in the relevance of pathological ideas and a gross violation of the pattern of behavior. Therefore, in all our observations in group 1, the actions of patients when they committed socially dangerous actions were not chaotic, disorderly, but purposeful and prepared. Thus, patient L., preparing to defend himself from “persecutors,” drew diagrams of the human body, noting the most vulnerable spots. The patient called this activity “practicing a retaliatory strike.” As his delirium worsened, he stabbed his “pursuer” with a knife in exactly the same place.

In another case, sick P. left a well-paid job and entered an institution as a watchman in order to have a gun; The patient soon killed his brother, the “pursuer,” with this gun.

Thus, despite the similarity of the studied groups of patients with continuous paranoid schizophrenia, there are significant differences between them in the duration, rate of development and degree of progression of the disease, which largely determine the social danger. One can come to the conclusion that there is a greater potential danger in more “safe” patients, whose behavioral motivation is associated with the existing delusional structure. These data require further clarification, but existing observations allow us to make certain considerations for preventing dangerous behavior in such patients.

First of all, this is, naturally, the early identification of patients with schizophrenia. In this case, due to the potential danger, special attention should be paid to patients with a relatively slow development of the process, the gradual formation of a delusional structure. At the same time, even when a diagnosis of schizophrenia is established in these cases, before committing illegal actions, it often remains difficult to resolve the issue of hospitalization of such patients, since the external preservation of correct behavior and the tendency to dissimulate prevent their timely placement in a psychiatric hospital.

Apparently, the provisions of the Instruction of the USSR Ministry of Health dated 26/VIII 1971 on emergency hospitalization of mentally ill patients who pose a public danger should be more widely applied here.

Unfortunately, in a significant proportion of the patients monitored, the diagnosis of schizophrenia was late; the diagnosis was established only during a forensic psychiatric examination. In these cases, it is important to prevent repeated socially dangerous actions and rational choice of medical measures. The long-term latent formation of a delusional structure, the intellectual integrity of patients, the tendency to dissimulation, the relevance of delusional experiences and the subordination of the patient’s entire behavior to pathological ideas dictate the need to place them in special psychiatric hospitals in accordance with Art. 58 of the Criminal Code of the RSFSR. M.F. came to the same conclusion. Taltse (1965) in the analysis of patients with low-progressive paranoid schizophrenia. Such a recommendation makes it possible to more completely isolate the patient from the object of delusion, carry out the necessary treatment and readaptation measures, the implementation of which can be difficult in general psychiatric hospitals due to the desire of such patients to hide their experiences, their tendency to escape and repeat antisocial actions due to delusional motivation of behavior.

These patients were examined at the Moscow City Psychiatric Hospital No. 8 named after. Solovyova.