Traditionally, the following forms of schizophrenia have been distinguished:

Simple schizophrenia is characterized by the absence of productive symptoms and the presence of only schizophrenic symptoms proper in the clinical picture.

Hebephrenic schizophrenia (may include hebephrenic-paranoid and hebephrenic-catatonic states).

Catatonic schizophrenia (pronounced impairment or lack of movement; may include catatonic-paranoid states).

Paranoid schizophrenia (there is delusions and hallucinations, but there is no speech disorder, erratic behavior, emotional impoverishment; includes depressive-paranoid and circular options).

Now there are also the following forms of schizophrenia:

Hebephrenic schizophrenia

Catatonic schizophrenia

paranoid schizophrenia

Residual schizophrenia (intensity of positive symptoms is low)

Mixed, undifferentiated schizophrenia (schizophrenia does not belong to any of the listed forms)

The most common form of paranoid schizophrenia, which is characterized mainly by delusions of persecution. Although other symptoms such as thought disturbances and hallucinations are also present, the delusions of persecution are the most conspicuous. It is usually accompanied by suspicion and hostility. The constant fear generated by delusional ideas is also characteristic. Delusions of persecution may be present for years and develop to a large extent. As a rule, in patients with paranoid schizophrenia, there are neither noticeable changes in behavior, nor intellectual and social degradation, which are noted in patients with other forms. The functioning of the patient may seem surprisingly normal until his delusions are affected.

The hebephrenic form of schizophrenia differs from the paranoid form both in terms of symptoms and outcome. The predominant symptoms are marked mental difficulties and disturbances of affect or mood. Thinking can be so disorganized that it loses (or almost loses) the ability to communicate meaningfully; affect in most cases is inadequate, the mood does not correspond to the content of thinking, so that as a result, sad thoughts can be accompanied by a cheerful mood. In the long term, most of these patients expect a pronounced disorder of social behavior, manifested, for example, by a tendency to conflict and an inability to maintain a job, family, and close human relationships.

Catatonic schizophrenia is characterized primarily by abnormalities in the motor sphere, present almost throughout the course of the disease. Anomalous movements are very diverse; these may be posture and facial expressions, or performing almost any movement in a strange, unnatural way. The patient can spend hours in an absurd and uncomfortable mannered posture, alternating it with unusual actions such as repetitive stereotypical movements or gestures. The facial expression of many patients is frozen, facial expressions are absent or very poor; there may be some grimaces like puckering lips. Seemingly normal movements are sometimes interrupted suddenly and inexplicably, sometimes giving way to strange motor behavior. Along with pronounced motor anomalies, many other symptoms of schizophrenia, already discussed, are noted - paranoid delusions and other thought disorders, hallucinations, etc. The course of the catatonic form of schizophrenia is similar to hebephrenic, however, severe social degradation, as a rule, develops in the later period of the disease.

Another "classic" type of schizophrenia is known, but it is extremely rare and its isolation as a separate form of the disease is disputed by many experts. This is simple schizophrenia, first described by Bleuler, who applied the term to patients with impaired thinking or affect, but without delusions, catatonic symptoms, or hallucinations. The course of such disorders is considered progressive with an outcome in the form of social maladaptation.

The book edited by A. S. Tiganov “Endogenous mental illness” provides a more expanded and supplemented classification of the forms of schizophrenia. All data is summarized in one table:

“The question of the classification of schizophrenia since its separation into an independent nosological form remains debatable. There is still no single classification of clinical variants of schizophrenia for all countries. However, there is a certain continuity of modern classifications with those that appeared when schizophrenia was identified as a nosologically independent disease. In this regard, E. Kraepelin's classification, which is still used by both individual psychiatrists and national psychiatric schools, deserves special attention.

E. Kraepelin singled out catatonic, hebephrenic and simple forms of schizophrenia. With simple schizophrenia that occurs in adolescence, he noted a progressive impoverishment of emotions, intellectual unproductiveness, loss of interests, increasing lethargy, isolation, he also emphasized the rudimentary nature of positive psychotic disorders (hallucinatory, delusional and catatonic disorders). He characterized hebephrenic schizophrenia as foolishness, broken thinking and speech, catatonic and delusional disorders. Both simple and hebephrenic schizophrenia are characterized by an unfavorable course, while E. Kraepelin did not rule out the possibility of remissions in hebephrenia. In the catatonic form, the predominance of the catatonic syndrome was described in the form of both catatonic stupor and excitation, accompanied by pronounced negativism, delusional and hallucinatory inclusions. With the paranoid form identified later, the dominance of delusional ideas, usually accompanied by hallucinations or pseudo-hallucinations, was noted.

Later, circular, hypochondriacal, neurosis-like and other forms of schizophrenia were also identified.

The main disadvantage of E. Kraepelin's classification is its statistical nature, associated with the main principle of its construction - the predominance of one or another psychopathological syndrome in the clinical picture. Further studies confirmed the clinical heterogeneity of these forms and their different outcomes. For example, the catatonic form turned out to be completely heterogeneous in the clinical picture and prognosis, heterogeneity of acute and chronic delusional states, hebephrenic syndrome was found.

The ICD-10 has the following forms of schizophrenia: paranoid simple, hebephrenic, catatonic, undifferentiated and residual. Also included in the classification of the disease are post-schizophrenic depression, "other forms" of schizophrenia, and unspecified schizophrenia. If no special comments are required for the classical forms of schizophrenia, then the criteria for undifferentiated schizophrenia seem extremely amorphous; As for post-schizophrenic depression, its selection as an independent rubric is a matter of debate to a large extent.

Studies of the patterns of development of schizophrenia, conducted at the Department of Psychiatry of the Central Institute for Postgraduate Medical Education and at the Scientific Center for Mental Health of the Russian Academy of Medical Sciences under the direction of A. V. Snezhnevsky, showed the validity of a dynamic approach to the problem of morphogenesis and the importance of studying the relationship between the type of course of the disease and its syndromic characteristics at each stage the development of the disease.

Based on the results of these studies, 3 main forms of the course of schizophrenia were identified: continuous, recurrent (periodic) and paroxysmal-progressive with varying degrees of progression (roughly, medium, and low-progression).

Continuous schizophrenia included cases of the disease with a gradual progressive development of the disease process and a clear distinction between its clinical varieties according to the degree of progression - from sluggish with mild personality changes to grossly progressive with the severity of both positive and negative symptoms. Sluggish schizophrenia is classified as continuous schizophrenia. But given that it has a number of clinical features and in the above sense its diagnosis is less certain, a description of this form is given in the section "Special forms of schizophrenia". This is reflected in the classification below.

The paroxysmal course that distinguishes recurrent, or periodic, schizophrenia is characterized by the presence of phases in the development of the disease with the occurrence of distinct attacks, which brings this form of the disease closer to manic-depressive psychosis, especially since affective disorders occupy a significant place here in the picture of seizures, and personality changes expressed indistinctly.

An intermediate place between the indicated types of flow is occupied by cases when, in the presence of a continuous disease process with neurosis-like, paranoid, psychopathic disorders, the appearance of seizures is noted, the clinical picture of which is determined by syndromes similar to attacks of recurrent schizophrenia or with conditions of a different psychopathological structure characteristic of - progressive schizophrenia.

The above classification of the forms of the course of schizophrenia reflects opposite trends in the development of the disease process - favorable with a characteristic paroxysmal and unfavorable with its inherent continuity. These two tendencies are most pronounced in typical variants of continuous and intermittent (recurrent) schizophrenia, but there are many transitional variants between them, creating a continuum of the course of the disease. This must be taken into account in clinical practice.

Here we present a classification of the forms of the course of schizophrenia, focused not only on the most typical variants of its manifestations, but on atypical, special forms of the disease.

Classification of forms of schizophrenia

continuously flowing

Malignant juvenile

hebephrenic

Catatonic

paranoid juvenile

paranoid

crazy option

hallucinatory variant

Sluggish

Paroxysmal-progredient

Malignant

Close to paranoid

Close to sluggish

Recurrent:

With different types of seizures

with the same seizures

special shapes

Sluggish

Atypical protracted pubertal attack

paranoid

Febrile

Since doctors and scientists now quite often have to diagnose schizophrenia not only according to the domestic classification, but also according to ICD-10, we decided to give an appropriate comparison of the forms of the disease (Table 7) according to A. S. Tiganov, G. P. Panteleeva, O.P. Vertogradova et al. (1997). In Table 7 there are some discrepancies with the above classification. They are due to the peculiarities of the ICD-10. In it, for example, among the main forms, there is no sluggish schizophrenia distinguished in the domestic classification, although this form was listed in the ICD-9: heading 295.5 "Slow (low-progressive, latent) schizophrenia" in 5 variants. In the ICD-10, low-grade schizophrenia basically corresponds to "Schizotypal disorder" (F21), which is included in the general rubric "Schizotypal and delusional disorders" (F20-29). In Table 7, among the forms of paroxysmal-progressive schizophrenia, the previously distinguished [Nadzharov R. A., 1983] schizoaffective schizophrenia is left, since in ICD-10 it corresponds to a number of distinguished conditions, taking into account the forms (types) of the course of the disease. In this Guide, schizoaffective schizophrenia is classified as schizoaffective psychosis and is discussed in Chapter 3 of this section. In the Guide to Psychiatry, edited by A.V. Snezhnevsky (1983), schizoaffective psychoses were not distinguished. ”

Table 7. Schizophrenia: comparison of ICD-10 diagnostic criteria and Russian classification

Schizophrenia is equally common among both sexes.

The issue of the prevalence of the disease is very complicated due to the different principles of diagnosis in different countries and different regions within the same country, the lack of a single complete theory of schizophrenia. The average prevalence is about 1% in the population, or 0.55%. There are data on more frequent incidence among the urban population.

In general, the diagnostic boundaries between different forms of schizophrenia are somewhat vague, and ambiguity can and does occur. Nevertheless, the classification carried out has been preserved since the early 1900s, since it turned out to be useful both for predicting the outcome of the disease and for describing it.

Psychological features of patients with schizophrenia

Since the time of E. Kretschmer, schizophrenia has been associated with a schizoid personality, which in the most typical cases is characterized by introversion, a tendency to abstract thinking, emotional coldness and restraint in the manifestations of feelings, combined with an obsession in the implementation of certain dominant aspirations and hobbies. But as they studied the various forms of the course of schizophrenia, psychiatrists moved away from such generalized characteristics of premorbid patients, which turned out to be very different in different clinical forms of the disease [Nadzharov R. A., 1983].

There are 7 types of premorbid personality traits in patients with schizophrenia: 1) hyperthymic personalities with features of immaturity in the emotional sphere and a tendency to daydreaming and fantasizing; 2) sthenic schizoids; 3) sensitive schizoids; 4) dissociated, or mosaic, schizoids; 5) excitable personalities; 6) "exemplary" personalities; 7) deficit personalities.

A premorbid personality type of a hyperthymic type has been described in patients with a paroxysmal form of schizophrenia. Stenic schizoids are found in its various forms. Sensitive schizoids are described both in paroxysmal forms of schizophrenia and in its sluggish course. The personality warehouse of the type of dissociated schizoids is characteristic of sluggish schizophrenia. Excitable personalities are found in various forms of the disease (with paroxysmal, paranoid and sluggish). Types of "exemplary" and deficient personalities are especially characteristic of forms of malignant juvenile schizophrenia.

Significant progress in the study of premorbid was achieved after the establishment of the psychological characteristics of patients, in particular, in identifying the structure of the schizophrenic defect.

Interest in the psychology of patients with schizophrenia arose long ago due to the peculiarity of mental disorders in this disease, in particular due to the unusual nature of cognitive processes and the inability to evaluate them in accordance with the known criteria of dementia. It was noted that the thinking, speech and perception of patients are unusual and paradoxical, which have no analogy among other known types of the corresponding mental pathology. Most authors pay attention to a special dissociation that characterizes not only cognitive, but also the entire mental activity and behavior of patients. So, patients with schizophrenia can perform complex types of intellectual activity, but often experience difficulty in solving simple tasks. Often, their ways of acting, inclinations and hobbies are also paradoxical.

Psychological studies have shown that disturbances in cognitive activity in schizophrenia occur at all its levels, starting from the direct sensory reflection of reality, i.e., perception. Different properties of the surrounding world are distinguished by patients in a slightly different way than healthy ones: they are “accentuated” in different ways, which leads to a decrease in the efficiency and “economics” of the perception process. However, at the same time, an increase in the “perceptual accuracy” of the perception of the image is noted.

The most clearly marked features of cognitive processes appear in the thinking of patients. It was found that in schizophrenia there is a tendency to actualize practically insignificant features of objects and a decrease in the level of selectivity due to the regulatory influence of past experience on mental activity. At the same time, the indicated pathology of mental, as well as speech activity and visual perception, designated as dissociation, appears especially clearly in those types of activity, the implementation of which is significantly determined by social factors, that is, it involves reliance on past social experience. In the same types of activity, where the role of social mediation is insignificant, no violations are found.

The activity of patients with schizophrenia due to a decrease in social orientation and the level of social regulation is characterized by a deterioration in selectivity, but in this regard, patients with schizophrenia can in some cases "gain", experiencing less difficulties than healthy people, if necessary, to discover "latent" knowledge or discover new ones in the subject. properties. However, the "loss" is immeasurably greater, since in the vast majority of everyday situations, a decrease in selectivity reduces the effectiveness of patients' activities. The decrease in selectivity is at the same time the foundation of "original" and unusual thinking and perception of patients, allowing them to consider phenomena and objects from different angles, compare the incomparable, move away from patterns. There are many facts confirming the presence of special abilities and inclinations in persons of the schizoid circle and patients with schizophrenia, allowing them to achieve success in certain areas of creativity. It is these features that gave rise to the problem of "genius and insanity."

By a decrease in the selective actualization of knowledge, patients significantly differ from healthy ones, who, according to premorbid features, belong to sthenic, mosaic, and hyperthymic schizoids. An intermediate position in this respect is occupied by sensitive and excitable schizoids. These changes are uncharacteristic for patients referred in premorbid to deficient and "exemplary" personalities.

Features of the selectivity of cognitive activity in speech are as follows: in patients with schizophrenia, there is a weakening of the social determination of the process of speech perception and a decrease in the actualization of speech connections based on past experience.

In the literature, for a relatively long time, there is evidence of the similarity of the "general cognitive style" of thinking and speech of patients with schizophrenia and their relatives, in particular parents. The data obtained by Yu. F. Polyakov et al. (1983, 1991), during experimental psychological studies conducted at the Scientific Center for Mental Health of the Russian Academy of Medical Sciences, indicate that among the relatives of mentally healthy patients with schizophrenia there is a significant accumulation of persons with varying degrees of severity of cognitive activity anomalies, especially in cases where they are characterized by personality traits similar to probands. In the light of these data, the problem of “genius and insanity” also looks different, which should be considered as an expression of the constitutional nature of the identified changes in thinking (and perception) that contribute to the creative process.

In a number of recent works, some psychological characteristics are considered as factors of predisposition (“vulnerability”), on the basis of which schizophrenic episodes can occur due to stress. As such factors, employees of the New York group L. Erlenmeyer-Kimung, who have been studying high-risk children for schizophrenia for many years, highlight the lack of information processes, attention dysfunction, impaired communication and interpersonal functioning, low academic and social “competence”.

The general result of such studies is the conclusion that the deficiency of a number of mental processes and behavioral reactions characterizes both the patients with schizophrenia themselves and those with an increased risk of developing this disease, i.e., the corresponding features can be considered as predictors of schizophrenia.

The peculiarity of cognitive activity revealed in patients with schizophrenia, which consists in a decrease in the selective actualization of knowledge, does not. is a consequence of the development of the disease. It is formed before the manifestation of the latter, predispositionally. This is evidenced by the absence of a direct relationship between the severity of this anomaly and the main indicators of the movement of the schizophrenic process, primarily its progression.

Note that in the course of the disease process, a number of characteristics of cognitive activity undergo changes. Thus, the productivity and generalization of mental activity, the contextual conditioning of speech processes decrease, the semantic structure of words falls apart, etc. However, such a feature as a decrease in selectivity is not associated with the progression of the disease process. In connection with what has been said in recent years, the psychological structure of a schizophrenic defect, the pathopsychological syndrome of a schizophrenic defect, has attracted especially great attention. In the formation of the latter, two trends are distinguished - the formation of a partial, or dissociated, on the one hand, and a total, or pseudo-organic defect, on the other [Kritskaya V.P., Meleshko T.K., Polyakov Yu.F., 1991]..

The leading component in the formation of a partial, dissociated type of defect is a decrease in the need-motivational characteristics of social regulation of activity and behavior. The insufficiency of this component of mental activity leads to a decrease in the social orientation and activity of the individual, to a lack of communication, social emotions, limits reliance on social standards and reduces the level of activity mainly in those areas that require reliance on past social experience and social criteria. The level of regulation remains quite high in these patients in those types of activities and in situations where the role of the social factor is relatively small. This creates a picture of dissociation and partial manifestation of mental disorders in these patients.

In the formation of this type of defect, which is designated as total, pseudo-organic, the decrease in the need-motivational component of mental activity comes to the fore, which manifests itself globally and covers all or most types of mental activity, which characterizes the patient's behavior as a whole. Such a total deficit of mental activity leads, first of all, to a sharp decrease in initiative in all spheres of mental activity, a narrowing of the range of interests, a decrease in the level of its arbitrary regulation and creative activity. Along with this, the formal-dynamic performance indicators are deteriorating, and the level of generalization is decreasing. It should be emphasized that a number of specific characteristics of a schizophrenic defect, which are so pronounced in the dissociated type of the latter, tend to smooth out due to a global decrease in mental activity. It is significant that this decrease is not a consequence of exhaustion, but is due to the insufficiency of need-motivational factors in the determination of mental activity.

In the pathopsychological syndromes that characterize different types of defect, both common and different features can be distinguished. Their common feature is the reduction of the need-motivational components of the social regulation of mental activity. This insufficiency is manifested by violations of the main components of the leading component of the psychological syndrome: in a decrease in the level of communication of social emotions, the level of self-awareness, and the selectivity of cognitive activity. These features are most pronounced with a defect of the partial type - a kind of dissociation of mental disorders occurs. The leading component of the second type of defect, pseudo-organic, is a violation of the need-motivational characteristics of mental activity, leading to a total decrease in mainly all types and parameters of mental activity. In this picture of a general decrease in the level of mental activity, only separate “islands” of preserved mental activity associated with the interests of patients can be noted. Such a total decrease smooths out the manifestations of dissociation of mental activity.

In patients, there is a close connection between negative changes characterizing a partial defect and constitutionally determined, premorbid personality traits. During the painful process, these features are modified: some of them deepen even more, and some smooth out. It is no coincidence that a number of authors have given this type of defect the name of a defect in the schizoid structure. In the formation of the second type of defect with a predominance of pseudo-organic disorders, along with the influence of constitutional factors, a more pronounced relationship with the factors of the disease process, primarily with its progression, is revealed.

An analysis of a schizophrenic defect from the standpoint of a pathopsychological syndrome makes it possible to substantiate the main principles of corrective actions for the purpose of social and labor adaptation and rehabilitation of patients, according to which the insufficiency of some components of the syndrome is partially compensated for by others, which are relatively more intact. Thus, the lack of emotional and social regulation of activity and behavior can be compensated to a certain extent in a conscious way on the basis of voluntary and volitional regulation of activity. The lack of need-motivational characteristics of communication can be overcome to some extent by including patients in specially organized joint activities with a clearly defined goal. The motivating stimulation used in these conditions does not appeal directly to the patient's feelings, but implies an awareness of the need to be oriented towards a partner, without which the task cannot be solved at all, i.e. compensation is achieved in these cases also due to the patient's intellectual and volitional efforts. One of the tasks of correction is to generalize and consolidate positive motivations created in specific situations that contribute to their transition into stable personal characteristics.

Genetics of schizophrenia

(M. E. Vartanyan/V. I. Trubnikov)

Population studies of schizophrenia - the study of its prevalence and distribution among the population made it possible to establish the main pattern - the relative similarity of the prevalence of this disease in mixed populations of different countries. Where the registration and detection of cases meet modern requirements, the prevalence of endogenous psychoses is approximately the same.

For hereditary endogenous diseases, in particular for schizophrenia, high rates of their prevalence in the population are characteristic. At the same time, a reduced birth rate has been established in families of patients with schizophrenia.

The lower reproductive capacity of the latter, explained by their long stay in the hospital and separation from the family, a large number of divorces, spontaneous abortions and other factors, other things being equal, would inevitably lead to a decrease in the incidence rate in the population. However, according to the results of population-epidemiological studies, the expected decrease in the number of patients with endogenous psychoses in the population does not occur. In this regard, a number of researchers suggested the existence of mechanisms that balance the process of elimination from the population of schizophrenic genotypes. It was assumed that heterozygous carriers (some relatives of patients), in contrast to patients with schizophrenia themselves, have a number of selective advantages, in particular, increased reproductive ability compared to the norm. Indeed, it has been proven that the birth rate of children in first-degree relatives of patients is higher than the average birth rates in this population group. Another genetic hypothesis that explains the high prevalence of endogenous psychoses in the population postulates the high hereditary and clinical heterogeneity of this group of diseases. In other words, the grouping under one name of diseases that are different in nature leads to an artificial overestimation of the prevalence of the disease as a whole.

A study of the families of probands suffering from schizophrenia convincingly showed the accumulation of cases of psychoses and personality anomalies, or “schizophrenic spectrum disorders” in them [Shakhmatova IV, 1972]. In addition to pronounced cases of manifest psychosis in families of patients with schizophrenia, many authors described a wide range of transitional forms of the disease and the clinical variety of intermediate options (sluggish course of the disease, schizoid psychopathy, etc.).

To this should be added some features of the structure of cognitive processes described in the previous section, which are characteristic of both patients and their relatives, usually evaluated as constitutional factors predisposing to the development of the disease [Kritskaya V.P., Meleshko T.K., Polyakov Yu.F. , 1991].

The risk of developing schizophrenia in the parents of patients is 14%, in brothers and sisters - 15-16%, in children of sick parents - 10-12%, in uncles and aunts - 5-6%.

There are data on the dependence of the nature of mental anomalies within the family on the type of course of the disease in the proband (Table 8).

Table 8. The frequency of mental anomalies in first-degree relatives of probands with various forms of schizophrenia (in percent)

Table 8 shows that among the relatives of a proband suffering from continuous-current schizophrenia, cases of psychopathy (especially of the schizoid type) accumulate. The number of secondary cases of manifest psychoses with a malignant course is much less. The reverse distribution of psychoses and personality anomalies is observed in families of probands with recurrent schizophrenia. Here the number of manifest cases is almost equal to the number of cases of psychopathy. These data indicate that the genotypes predisposing to the development of continuous and recurrent course of schizophrenia differ significantly from each other.

Many mental anomalies, as if transitional forms between the norm and severe pathology in families of patients with endogenous psychoses, led to the formulation of an important question for genetics about the clinical continuum. The continuum of the first type is determined by multiple transitional forms from complete health to manifest forms of continuous schizophrenia. It consists of schizothymia and schizoid psychopathy of varying severity, as well as latent, reduced forms of schizophrenia. The second type of clinical continuum is transitional forms from the norm to recurrent schizophrenia and affective psychoses. In these cases, the continuum is determined by the psychopathy of the cycloid circle and cyclothymia. Finally, between the very polar, "pure" forms of the course of schizophrenia (continuous and recurrent), there is a range of transitional forms of the disease (paroxysmal-progredient schizophrenia, its schizoaffective variant, etc.), which can also be designated as a continuum. The question arises about the genetic nature of this continuum. If the phenotypic variability of the manifestations of endogenous psychoses reflects the genotypic diversity of the mentioned forms of schizophrenia, then we should expect a certain discrete number of genotypic variants of these diseases, providing "smooth" transitions from one form to another.

Genetic-correlation analysis made it possible to quantify the contribution of genetic factors to the development of the studied forms of endogenous psychoses (Table 9). The heritability index (h 2) for endogenous psychoses varies within relatively narrow limits (50-74%). Genetic correlations between forms of the disease have also been determined. As can be seen from Table 9, the genetic correlation coefficient (r) between continuous and recurrent forms of schizophrenia is almost minimal (0.13). This means that the total number of genes included in the genotypes that predispose to the development of these forms is very small. This coefficient reaches its maximum (0.78) values ​​when comparing the recurrent form of schizophrenia with manic-depressive psychosis, which indicates an almost identical genotype predisposing to the development of these two forms of psychosis. In the paroxysmal-progredient form of schizophrenia, a partial genetic correlation is found with both the continuous and recurrent forms of the disease. All these patterns indicate that each of the mentioned forms of endogenous psychoses has a different genetic commonality in relation to each other. This commonality arises indirectly, due to genetic loci common to the genotypes of the corresponding forms. At the same time, there are also differences between them in terms of loci, which are characteristic only for the genotypes of each individual form.

Table 9. Genetic-correlation analysis of the main clinical forms of endogenous psychoses (h 2 - heritability coefficient, r g - genetic correlation coefficient)

Thus, the polar variants of endogenous psychoses are genetically most significantly different - Continuous schizophrenia, on the one hand, recurrent schizophrenia and manic-depressive psychosis, on the other. Paroxysmal-progressive schizophrenia is clinically the most polymorphic, genotypically also more complex and, depending on the predominance of elements of a continuous or periodic course in the clinical picture, contains certain groups of genetic loci. However, the existence of a continuum at the genotype level requires more detailed evidence.

The presented results of genetic analysis led to the emergence of issues that are important for clinical psychiatry in theoretical and practical terms. First of all, this is a nosological assessment of the group of endogenous psychoses. The difficulties here are that their various forms, while having common genetic factors, at the same time (at least some of them) differ significantly from each other. From this point of view, it would be more correct to designate this group as a nosological "class" or "genus" of diseases.

Developed ideas make us consider the problem of heterogeneity of diseases with hereditary predisposition in a new way [Vartanyan M. E., Snezhnevsky A. V., 1976]. Endogenous psychoses belonging to this group do not meet the requirements of classical genetic heterogeneity, proven for typical cases of monomutant hereditary diseases, where the disease is determined by a single locus, i.e., one or another of its allelic variants. The hereditary heterogeneity of endogenous psychoses is determined by significant differences in the constellations of different groups of genetic loci that predispose to certain forms of the disease. Consideration of such mechanisms of hereditary heterogeneity of endogenous psychoses allows us to evaluate the different role of environmental factors in the development of the disease. It becomes clear why in some cases the manifestation of the disease (recurrent schizophrenia, affective psychoses) often requires external, provoking factors, in others (continuous schizophrenia) the development of the disease occurs as if spontaneously, without significant environmental influence.

The decisive moment in the study of genetic heterogeneity will be the identification of the primary products of genetic loci involved in the hereditary structure, predispositions, and the assessment of their pathogenetic effects. In this case, the concept of "hereditary heterogeneity of endogenous psychoses" will receive a specific biological content, which will allow targeted therapeutic correction of the corresponding shifts.

One of the main directions in studying the role of heredity in the development of schizophrenia is the search for their genetic markers. Under markers, it is customary to understand those signs (biochemical, immunological, physiological, etc.) that distinguish patients or their relatives from healthy ones and are under genetic control, that is, they are an element of a hereditary predisposition to the development of the disease.

Many biological disorders found in patients with schizophrenia are more common in their relatives than in the control group of mentally healthy individuals. Such disorders were detected in a part of mentally healthy relatives. This phenomenon was demonstrated, in particular, for membranotropic, as well as for neurotropic and antithymic factors in the blood serum of patients with schizophrenia, whose heritability coefficient (h 2) is 64, 51 and 64, respectively, and the genetic correlation index with a predisposition to the manifestation of psychosis is 0, eight; 0.55 and 0.25. Recently, indicators obtained from CT of the brain have been very widely used as markers, since many studies have shown that some of them reflect a predisposition to the disease.

The obtained results are consistent with the concept of genetic heterogeneity of schizophrenic psychoses. At the same time, these data do not allow us to consider the entire group of psychoses of the schizophrenic spectrum as the result of a phenotypic manifestation of a single genetic cause (in accordance with simple models of monogenic determination). Nevertheless, the development of a marker strategy in the study of the genetics of endogenous psychoses should continue, as it can be the scientific basis for medical genetic counseling and the identification of high-risk groups.

Twin studies have played a large role in studying the "contribution" of hereditary factors in the etiology of many chronic non-communicable diseases. They were started in the 20s. Currently, in clinics and laboratories around the world there is a large sample of twins suffering from mental illness [Moskalenko VD, 1980; Gottesman I. I., Shields J. A., 1967, Kringlen E., 1968; Fischer M. et al, 1969; Pollin W. et al, 1969; Tienari P., 1971]. Analysis of the concordance of identical and fraternal twins (OB and BD) for schizophrenia showed that concordance in OB reaches 44%, and in BD - 13%.

The concordance varies significantly and depends on many factors - the age of the twins, the clinical form and severity of the disease, the clinical criteria for the condition, etc. These features determine the large difference in the published results: the concordance in the OB groups ranges from 14 to 69%, in the DB groups - from 0 to 28%. None of the diseases concordance in pairs of AB does not reach 100%. It is generally accepted that this indicator reflects the contribution of genetic factors to the occurrence of human diseases. Discordance between OBs, on the contrary, is determined by environmental influences. However, there are a number of difficulties in interpreting twin concordance data for mental illness. First of all, according to the observations of psychologists, one cannot exclude "mutual psychic induction", which is more pronounced in OB than in DB. It is known that OBs tend more towards mutual imitation in many areas of activity, and this makes it difficult to unambiguously determine the quantitative contribution of genetic and environmental factors to the similarity of OBs.

The twin approach should be combined with all other methods of genetic analysis, including molecular biology.

In the clinical genetics of schizophrenia, when studying the relationship between hereditary and external factors in the development of mental illness, the most common approach is the study of "adopted children - parents." Children in early childhood are separated from biological parents with schizophrenia and transferred to families of mentally healthy people. Thus, a child with a hereditary predisposition to mental illness enters a normal environment and is brought up by mentally healthy people (adoptive parents). With this method, S. Kety et al. (1976) and other researchers convincingly proved the essential role of hereditary factors in the etiology of endogenous psychoses. Children whose biological parents suffered from schizophrenia who grew up in families of mentally healthy people showed symptoms of the disease with the same frequency as children left in families with schizophrenia. Thus, studies of "adopted children - parents" in psychiatry allowed to reject objections to the genetic basis of psychoses. The primacy of psychogenesis in the origin of this group of diseases was not confirmed in these studies.

In recent decades, another direction of genetic research in schizophrenia has been formed, which can be defined as the study of "high-risk groups". These are special multi-year follow-up projects for children born to parents with schizophrenia. The most famous are the studies of V. Fish and the New York High Risk Project, which has been carried out at the Institute of Psychiatry in the State of New York since the late 60s. B. Fish have been established phenomena of dysontogenesis in children from high-risk groups (for a detailed presentation, see Volume 2, Section VIII, Chapter 4). The children observed in the New York project have now reached adolescence and adulthood. According to neurophysiological and psychological (psychometric) indicators, a number of signs reflecting the characteristics of cognitive processes were established, characterizing not only mentally ill, but also practically healthy individuals from a high-risk group, which can serve as predictors of the onset of schizophrenia. This makes it possible to use them to identify contingents of people in need of appropriate preventive measures.

Literature

1. Depression and depersonalization - Nuller Yu.L. Address: Scientific Center for Mental Health of the Russian Academy of Medical Sciences, 2001-2008 http://www.psychiatry.ru

2. Endogenous mental illness - Tiganov A.S. (ed.) Address: Scientific Center for Mental Health of the Russian Academy of Medical Sciences, 2001-2008 http://www.psychiatry.ru

3. MP Kononova (Guidelines for the psychological study of mentally ill children of school age (From the experience of a psychologist in a children's psychiatric hospital). - M .: State Publishing House of Medical Literature, 1963.S.81-127).

4. "Psychophysiology" ed. Yu. I. Aleksandrova

Diseases of the nervous system are quite common in people with a hereditary predisposition. Most of them are treatable, after which the person returns to a full life. But, this is what schizophrenia is and whether it is possible to get rid of it completely or not, unfortunately, even a qualified doctor still cannot answer these questions accurately. But the fact that this disease leads to a complete loss of ability to work has been proven repeatedly.

Schizophrenia is one of the most dangerous ailments of the nervous system, which suppresses the will of the patient, which ultimately leads to a deterioration in the quality of his life. However, in some cases, the development of pathology can be suspended, preventing disability. The types of schizophrenia and, accordingly, its forms can be different, and they differ significantly from each other, but psychiatrists say that this disease is not one ailment, but several types of illness.

Despite the observations and research of specialists, the origin of the syndrome has not been fully established. Therefore, schizophrenia and its symptoms are still a hot topic. And in the common people, this disease is known under such a name as “split personality” (due to the patient’s behavior, the illogicality of his thinking). Most often, the early symptoms of pathology make themselves felt at the age of 15-25 years, and in the absence of adequate therapy, they rapidly progress.

The main role in the appearance of the disease is played by the hereditary factor. External causes (disorders of the psyche, nervous system, past illnesses, head injuries, etc.) are only of secondary importance and are only an activator of the pathological process.

How does the insidious syndrome manifest itself?

Experts are cautious about the study of schizophrenia and the final definition of this diagnosis. A wide range of possible disorders is being investigated: neurosis-like and mental.

Among the emotional symptoms of the disease, the main signs are:

• Prostration - a person has complete indifference in the fate of people close to him.
• Inappropriate behavior is also present - in some cases there is a strong reaction to various stimuli: every trifle can cause aggression, attacks of inadequate jealousy, anger. They suffer, and from this native people. With strangers, the patient behaves as usual. The first signs of schizophrenia are the loss of interest in everyday activities, things.
• Dullness of instinct - a person suddenly has a loss of food, he has no desire to lead a normal life, to monitor his appearance. All syndromes of schizophrenia are also accompanied by delusions, manifested in the wrong perception of everything that is happening around.
• The patient sees strange colored dreams, he is haunted by obsessive thoughts that someone is constantly watching him, wants to deal with him in sophisticated ways. The patient is trying to convict his other half of treason (while his behavior in schizophrenia is obsessive).
• Hallucinations - often such a disorder makes itself felt in the form of hearing impairment: the patient hears extraneous voices that prompt him with various ideas. The patient may also be disturbed by visual color hallucinations resembling a dream.
• Disturbance of normal thinking. A disease such as schizophrenia, the main symptoms and signs of which are often quite difficult to identify, is accompanied by deviations in the thought process. One of the most serious violations is disorganization in the perception of various information, in which the person’s logic is completely absent. Speech is lost in connection, sometimes it is impossible to make out what the patient is saying.

Another sign is a delay in the thought process (the person cannot finish his story). If you ask the patient why he suddenly stopped, he will not be able to answer this question.

• Movement disorders. The causes of schizophrenia may be different, but regardless of its origin, the patient often has involuntary, awkward and scattered movements, strange mannerisms, and various grimaces. The patient can systematically repeat certain actions or fall into prostration - a state of immunity, complete immobility.

If there is no treatment for schizophrenia, then the catatonic syndrome is the first symptom observed in a person. Thanks to modern therapeutic techniques, this phenomenon is quite rare.

If the first signs of schizophrenia are almost impossible to detect at the initial stage of the pathology, then it is impossible to lose sight of hallucinations and delusions.

In families where bouts of unjustified jealousy and scandals, aggression, depression are constantly present, many refer to mental disorders, and only in the last place, relatives begin to think that this is schizophrenia, the main symptoms and signs of which are not yet so pronounced. But with a good relationship, the disease is easy to identify in the initial stages of its development.

The main forms of the syndrome

Specialists identify the main types of schizophrenia and, accordingly, its forms.

Schizophrenic psychosis and "split personality" are two types of pathology, the course of which is sometimes similar. Clinical signs, most likely, act as additional symptoms of the syndrome, which may not appear. Psychosis is dominated by hallucinations and delusions. Schizophrenia is treatable (you can stop its progression), but for this it is necessary to recognize it in a timely manner.

Alcohol syndrome: signs

This pathology, as such, does not exist, but the systematic use of alcohol can trigger the mechanism for the development of the disease. The state in which a person is after a long "binge" is called psychosis and is a mental illness and does not apply to schizophrenia. But because of inadequate behavior, people call this disease alcoholic schizophrenia.

Psychosis after prolonged alcohol consumption can occur in several ways:

1. Delirium tremens - appears after giving up alcohol and is characterized by the fact that a person begins to see various animals, devils, living beings, strange objects. In addition, he does not understand what is happening to him and where he is. In this case, schizophrenia is curable - you just need to stop abusing alcohol.
2. Hallucinosis - appear during prolonged alcohol consumption. The patient is disturbed by visions of an accusatory or threatening nature. Is schizophrenia treatable or not? Yes, in this case, you can get rid of it, after proper therapy.
3. Delusional syndrome - observed with systematic, prolonged consumption of alcohol. Characterized by poisoning attempts, harassment and jealousy.

A disease such as schizophrenia is dangerous and the causes of its occurrence in this case play a special role, since after giving up alcohol and appropriate treatment, you can get rid of the pathology forever.

How to establish the presence of a "split personality"?

Schizophrenia and its diagnosis play a special role in a patient's life. Therefore, it is necessary to establish the presence of an ailment in a timely manner. According to the established rules, the examination is carried out according to certain criteria and in sufficient detail. First, primary information is collected, including a medical survey, complaints, and the nature of the development of the disease.

What kind of disease it is and the main reasons for the rapid development of schizophrenia can be found using the main diagnostic methods:

1. Special testing of psychological orientation. This technique is informative at the initial stages of the disease.
2. MRI of the brain - through this procedure, the presence of certain disorders in the patient (encephalitis, hemorrhage, malignant neoplasms) that can affect a person's behavior is revealed. Since the symptoms of the disease, regardless of the type of disease, are somewhat similar to the signs of organic brain disorders.
3. Electroencephalography - establishes injuries, pathologies of the brain.
4. Research in the laboratory: biochemistry, urinalysis, hormonal status, as well as an immunogram.

To determine the exact diagnosis, additional examination methods are used: arterial examination, sleep study, virological diagnostics. It is only possible to finally identify the manifestation of a "split personality" and prescribe an adequate treatment for schizophrenia if a person has signs of the syndrome for six months. Must establish at least one overt, as well as several vague symptoms:

• violation of the normal thought process, in which the patient believes that his thoughts do not belong to him;
• feeling of influence from the outside: the belief that all actions are carried out under the direction of an outsider;
• inadequate perception of behavior or speech;
• hallucinations: olfactory, auditory, visual, and also tactile;
• obsessive thoughts (for example, excessive jealousy);
• confusion of consciousness, failures of motor functions: restlessness or stupor.

With a comprehensive examination of the pathology, every tenth patient is misdiagnosed, since the causes of schizophrenia, as well as its manifestation, can be different, so it is not always possible to identify a dangerous illness in a timely manner.

How to provide adequate therapy

Most psychiatrists suggest that the treatment of schizophrenia, that is, the stage of its exacerbation, is best done in a hospital, especially with the first mental disorder. Of course, the hospital should be well equipped and use only modern methods of diagnosis and therapy. Only in this case it is possible to obtain a more accurate picture of the disease, as well as to select the appropriate methods of treatment for schizophrenia.

But do not forget that being in a hospital is stressful for a patient, because it completely limits his freedom of action. Therefore, hospitalization must be fully justified, the decision must be made taking into account all factors and after exploring other alternatives.

Duration of adequate therapy

Regardless of the type of schizophrenia, the treatment of the disease should be constant and long enough. Often, after the first attack, therapy with psychotropic drugs and antipsychotics is prescribed for several years, and after a second episode - at least five.

About 70% of patients stop taking the medicine, as they feel completely healthy, not realizing that they have just entered the remission stage. Another category of patients suffering from schizophrenia refuses maintenance medications due to lack of effectiveness of therapy, as well as weight gain and drowsiness.

How to prevent possible relapses?

The main task of therapy is the treatment of the disease, aimed at preventing seizures. For these purposes, doctors use long-acting medications: Rispolept-Konsta, Fluanxol-Depot, and only in some cases because of the negative effect on the symptoms of the Clopixol-Depot syndrome.

Supportive therapy should be long-term and carried out under the constant supervision of physicians, taking into account the rate of development of biochemical, hormonal, and neurophysiological parameters, and include psychotherapy sessions with the patient. It is necessary to teach the patient's relatives the tactics of their behavior, which will prevent the recurrence of the disease.

Are people with split personality disorder aggressive?

Patients with a diagnosis such as schizophrenia are practically not prone to psychosis, violence, most often they prefer peace. According to statistics, if the patient has never crossed the boundaries of the law, then even after he has a disease, he will not commit a crime. If someone with a diagnosis of "split personality" behaves aggressively, then often his actions are directed at people close to him and manifest themselves within the home.

The treatment of the “split personality” syndrome is a rather difficult task, both for the public and for physicians. Therefore, the question of whether schizophrenia can be cured remains relevant to this day. Timely therapy and medicines preserve the quality of the patient's habitual lifestyle, ability to work and social level, thereby allowing him to provide for himself and help his loved ones.

Schizophrenia(literally: "split, splitting of the mind") - a complex of mental disorders that have similar signs and symptoms. In schizophrenia, all manifestations of mental activity are affected: thinking, perception and response (affect), emotions, memory. Therefore, the symptoms of schizophrenia are both pronounced and vague, and its diagnosis is difficult. The nature of schizophrenia is still largely a mystery; only the factors provoking it and, in the most general terms, the initial mechanism are known. Schizophrenia is the third leading cause of permanent disability and disability. More than 10% of schizophrenics attempt suicide.

Forms

Four forms of schizophrenia are generally recognized. Different psychiatric schools define them differently and classify their varieties, schizophrenic disorders, psychoses in different ways. In Russian psychiatry, the following division is accepted:

1. Simple– no hallucinations, delusions, obsessions. It's just that the personality is gradually disintegrating. It used to be called progressive dementia. A rare but dangerous form: you can recognize it when things have already gone far.
2. At hebephrenic schizophrenia, thinking and memory are largely or completely preserved, but in the emotional-volitional plan, the patient may be unbearable for others. An example is Howard Hughes mentioned above.
3. Catatonic schizophrenia- alternation of periods of frenzied senseless activity with waxy flexibility and stupor. In the active phase, the patient can be dangerous to himself and others. That is why at the slightest sign of it, you need to urgently consult a doctor. Moreover, the patient may refuse to speak and it is useless to talk to him.
4. paranoid schizophrenia- "schizophrenia as it is", with all the schizophrenic "bouquet": delusions, hallucinations, obsessions. The most common form. Methods for the treatment of schizophrenia of the paranoid type are the most developed. It is for this form that cases of self-healing of patients are noted. Patients are most often not dangerous, but are easily provoked to violence.

The reasons

The cause of schizophrenia can be: heredity, difficult childhood, stress, nervous and organic (bodily) diseases that affect the nervous system - syphilis, AIDS. Alcoholism and drug addiction can both cause disease and be its consequence. A complete cure for schizophrenia is not possible; at best, it is possible to return the patient to society. However, there are many cases when patients independently got rid of the disease.

A person runs the risk of developing schizophrenia when he artificially evokes pleasant memories or sensations, either on his own or with the help of stimulants, by increasing the concentration of the “feel good hormone” - dopamine in the blood. In fact, dopamine is not a hormone, but a neurotransmitter, a substance that regulates nerve activity. In addition to dopamine, there are other neurotransmitters.

With regular “self-injection” of dopamine, tolerance (resistance) to it develops, and the effect of self-stimulation measures is weakened. An ignorant person increases stimulation, a vicious circle is formed. In the end, the left, "speaking" and right, "remembering" hemispheres of the brain, unable to withstand the overload, lose coordination with each other. This is the beginning of the disease.

The patient begins to hallucinate: he sees visions, hears voices, objects allegedly transform and begin to perform functions unusual for them. But the patient thinks that all this is in fact. Gradually hallucinations more and more displace reality and replace it. In the end, the patient finds himself in an imaginary world, in comparison with which Dante's hell is an amusement park.

Without outside help, over time, the brain becomes obsessed (without quotes) in the ocean of chaos generated by it, and catatonia sets in - complete immobility and detachment from everything. But inside the process is still going on, sooner or later the brain completely loses control over its receptacle, the vital functions of the body are disturbed, and then - death. The course of the disease, from hypertrophied, under the influence of drugs, imagination to a state preceding catatonia, can be traced by a selection of drawings of patients.

Schizophrenia should not be confused with a split personality. In schizophrenia, the personality, figuratively speaking, does not diverge in two, but breaks up into small fragments that have no independent meaning.

Schizophrenics, contrary to popular belief, are not capable of unprovoked aggression. But, like all mentally ill people, they are easily provoked. If, according to the World Health Organization, about 1% of the world's population is affected by schizophrenia, then among those sentenced to death and life imprisonment, the proportion of schizophrenics is 10%.

Provocateurs for a schizophrenic can be both a hostile attitude towards him, and inappropriate sensitivity, "lisping." According to the recollections of patients who overcame the disease, their condition improved when others treated them as ordinary, not mentally ill. And the same people around confirm that with such an attitude, the sick also gave them much less trouble.

Schizophrenia can proceed both smoothly and in attacks. In breaks (remissions) the patient is completely normal. With timely assistance, you can achieve a stable remission for many years or even for the rest of your life.

There is a so-called "anti-psychiatric movement" under the slogan: "There are no abnormal people, there are abnormal circumstances." The harm from it is difficult to overestimate. By analogy: to be naked in the cold means to fall into abnormal circumstances. But inflammation of the lungs and frostbite as a result are dangerous diseases that need to be treated so as not to remain crippled or die.

signs

Schizophrenia most often begins and develops gradually. The most risky age is almost mature teenagers and not quite mature adults. It is possible to detect the onset of the disease 30 months before its obvious manifestation (prodrome period). The first signs of schizophrenia, in descending order of importance, are:

• A person suddenly freezes in a certain position, and his body acquires a waxy flexibility: take his hand, lift it, it will remain so.
• A person conducts a dialogue with someone imaginary, not paying attention to the real ones, and if he is brought out of this state by a sharp impact, he cannot explain with whom and what he was talking about.
• Sperrungs appear in the patient’s speech: he talks about something in detail or with enthusiasm, suddenly stops in mid-sentence, and cannot answer the question: what was it about.
• Senseless repetition of actions or the same senseless refusal of them. Examples: a person up to a hole washes a place on clothes where there was once a stain that had been reduced for a long time. In the summer, being dirty and sweaty, he does not get a shower, and the demand to wash causes him obvious fear and disgust.
• Autism: a person, to the point of complete detachment, is fond of some business, not being able to obtain fundamental knowledge on it and explain what he is doing and why it is necessary. Einstein put it this way: "If a scientist cannot explain to a five-year-old child what he is doing, he is either a madman or a charlatan."
• A person freezes for a long time with a petrified face, looking at some very ordinary object: an iron, a garden bench, and after a shake he cannot explain what he saw there.
• Weakening of affect (combinations of perception with response): if such a person is suddenly pricked or pinched, he will not scream or be indignant, but will calmly wrap a face in you that looks like a plasticine mask with tin balls on both sides of the bridge of the nose. He shows the same indifference to the fate of both his enemies and people friendly to him.
• Passion for meaningless ideas. Let's say: "Boris Berezovsky is alive, he bought the right to return to Russia from Putin, had plastic surgery and is quietly living out his life somewhere." Or, showing all the signs of religious zeal, a person cannot explain what “a reed shaken by the wind”, “there is no prophet in his own country”, “let this cup pass from me” and other evangelical and biblical expressions that have become winged, mean.
• Rapid fatigue, fuzzy coordination of movements. When writing, especially when typing on a computer, letters in words often change places in pairs: “forged” instead of “indirect”, “counted” instead of “counted”. Knowing grammar, writes (types) without capital letters and punctuation marks.

With a single appearance of any of the first two signs, the patient should be immediately taken to a doctor. If signs 3 and 4 are systematically observed within a month, it is necessary to consult a psychiatrist or clinical psychologist without the knowledge of the patient. The same - if signs 5 and 6 are observed within 3 months. For signs 7-9 - within six months. According to signs 3-9, you must first talk with the patient, and start the countdown again. If he himself during the conversation expresses a desire to see a doctor, he must be satisfied without delay.

Note: in many urban subcultures, it is believed that "shiza is cool." Their representatives often turn out to be skillful simulators. The real patients are nothing more than a degraded everyday drunkard, a boor and an insolent person - a patient with alcoholism. A conversation with a psychologist will help clarify the situation in this regard and work out a course of action in this particular case.

The schizophrenic, unlike the impudent malingerer, does not try to pretend to be sick, he thinks that this is how it should be. Most often at the beginning of the disease, he is quite sociable and willingly talks about himself. But do not try, unless you want to harm the patient, to understand the symptoms of schizophrenia on your own, this is impossible without special knowledge and experience. Only a doctor can make a correct diagnosis, prescribe treatment and care that can return the patient to society. This is done according to three groups of symptoms:

Symptoms

Symptoms of the first rank

Symptoms of the first rank: one is enough for a diagnosis, but at home, in one's own circle, they cannot be recognized because of family, friendship or intimacy. If the child said: “Mom, I know what you are thinking about” - he may have just guessed from the expression on his face.

• Reading thoughts, exchanging thoughts, openness of thoughts (“And I have no roof at all, and everyone can see everything there”).
• The idea of ​​mastering the whole patient or part of his body by someone or something from outside.
• Imaginary voices coming from outside or from parts of the body.
• Ridiculous, most often grandiose ideas, defended contrary to the obvious. Examples: "Vitya Tsoi is cooler than God, and I'm cooler than Tsoi"; "My father is the President of Ukraine, and I am the President of the Universe."

Symptoms of the second rank

The symptoms of the second rank also indicate a mental disorder, but with one of them it may not be schizophrenia. To define schizophrenia, any two of the following must be present:

• Any persistent hallucinations, but without attempts to respond to them: the patient does not try to fight or fight with someone imaginary, go somewhere with him, enter into an intimate relationship. Psychiatrists call it simply: "No affect." Instead of hallucinations, there may be an obsession, which for the patient means more than life, “overvalued”, but does not aim at the universe. An example is the "teaching" of Howard Hughes about the three "white poisons" - bread, sugar and salt, because of which the outstanding aircraft designer, businessman and producer simply starved himself to death.
• Ragged, meaningless speech, neologisms that are inexplicable and unpronounceable by a normal person, sperrungs. Here is an example of this kind of "poetic creativity": Dranp childglyam untkvyrzel vrzhdglyam.” The patient claimed that these were spells with which he maintains contact with another reality. According to the recollections of the attending physician, he could spend hours pouring such combinations of sounds as peas.
• Catatonia, waxy flexibility, stupor.
• Autism.

Negative symptoms indicate the absence or weakening of something: willpower (apathy), the ability to sympathize and empathize (flattening of affect), self-isolation from society (sociopathy). Based on the analysis of the symptoms of each group, the doctor, according to psychiatric classifiers (of which there are several, and they differ significantly from each other), and from his own experience, recognizes the form of schizophrenia and prescribes treatment.

Treatment

Currently, schizophrenia is treated with antipsychotics, drugs that affect the circulation of neurotransmitters in the body. Antipsychotics are atypical (discovered first), and typical. Atypical regulate (suppress) the general exchange of mediators. They are stronger, and they are cheaper, but they cause persistent consequences (loss of potency and weakening of mental abilities), and even a severe, to the point of death, reaction of the body. Typical antipsychotics are much more expensive, but they are selective and gentler. It takes a long time and expensive to be treated with them until a stable remission, but the patient returns to society sooner.

In especially severe cases, the treatment of schizophrenia is carried out by methods of shock therapy: convulsions are artificially induced, electric shock is used. The goal is to “uncycle” the brain so that further treatment can be carried out in cooperation with the patient. Methods are cruel, but sometimes necessary. Cases are known when catatonic patients in psychiatric hospitals during a fire or under bombing suddenly jumped up and later behaved like normal people.

Brain surgery, like the one described by Robert Penn Warren in All the King's Men, is almost never done these days. The goal of modern psychiatry is not to protect others from the patient, but to return him to society.

The greatest difficulties in the treatment of schizophrenia are created by stigmatism, “branding”. “Shizik” is shunned, insulted, mocked by everyone. Instead of positive emotions that reduce the excess of dopamine, the patient receives negative ones that require an additional "injection" of it, and the disease worsens.

Can schizophrenia be beaten?

Yes, you can. With paranoid schizophrenia, the patient is able to distinguish hallucinations from reality for a long time, but they do not disturb him, they seem to him something funny, pleasant, a manifestation of some kind of superpowers. Remember, dopamine works in the body.

But, having found some kind of clue, you can “filter” hallucinations from reality and be completely cured. If the disease is noticed in the first stages, this can be done even unnoticed by others. In general, the more you get sick, the more you heal. World-famous examples are John Forbes Nash, an American mathematician, Nobel laureate in economics, the hero of the book and film Beautiful Mind, and the Norwegian psychologist Arnhild Lauveng, who, on her own, after several hospitalizations, achieved complete stable remission.

Sincerely,

These forms are not included in the framework of schizophrenia by all psychiatric schools. Sometimes they are considered as separate mental illnesses, sometimes they are included among other non-schizophrenic mental disorders - they are classified as personality disorders (psychopathies), manic-depressive psychosis, etc.

I. Sluggish schizophrenia- pseudoneurotic and pseudopsychopathic schizophrenia, borderline schizophrenia, schizotypal disorder according to ICD-10 (F-21), borderline and schizotypal personality disorder according to psychiatric systematics in the USA according to DSM-IV). The onset is gradual and development is usually slow. Even without treatment, significant improvements are possible, up to a practical recovery. The main negative symptoms of schizophrenia in this form are mild, sometimes hardly noticeable, especially at the onset of the disease. In some cases, the picture is similar to protracted neuroses, in others - to psychopathy.

BUT) Neurosis-like schizophrenia- most often resembles a picture of a protracted obsessive neurosis, less often hypochondriacal, neurotic depersonalization, and in adolescence - dysmorphomania and anorexia nervosa.

Obsessions differ from neurotic obsessions in their invincibility, their great force of coercion. Patients can perform ridiculous rituals for hours, not embarrassed by strangers. They can even force other people to perform rituals. Phobias lose their emotional component; fears are spoken of without emotion, they are especially absurd. However, influxes of obsessions can bring the patient to suicide.

Hypochondriacal complaints are extremely pretentious and absurd (“the bones are crumbling, “the intestines are huddled together”), painful senestopathies often occur. Asthenia is monotonous. Complaints about "changing oneself" more often testify to depersonalization; derealization appears in statements about the "invisible wall" between oneself and the outside world. Dysmorphomaniac experiences are ridiculous and have no basis. Anorectic syndrome is expressed in frilly and unusual diets, in a fuzzy and unmotivated reason for starvation. In boys, persistent anorexia often turns out to be the beginning of schizophrenia.

Along with neurosis-like disorders, ideas of relation may arise. Patients believe that everyone is looking at them, laughing at them, making indecent hints.

B) Psychopathic schizophrenia- (latent schizophrenia, heboid, pseudopsychopathic, prepsychotic or prodromal schizophrenia) - according to the clinical picture, it is similar to various types of psychopathy - schizoid, epileptoid, unstable, hysterical.

With schizoid psychopathy, the syndrome of increasing schizoidality is similar. Closeness intensifies. Relations with relatives and friends are deteriorating, life is filled with unusual hobbies, working capacity is falling; patients tend to experiment on themselves, it is absurd to fantasize.

In the presence of similarities with epileptoid psychopathy, in addition to constant gloom and isolation, cold cruelty is characteristic. Little motivated affects of malice appear and disappear suddenly. Sexuality can refer to family members (for boys, more often to the mother). Patients can harm themselves, are dangerous to others, and show sexual aggressiveness.

While similar to the clinic of unstable psychopathy, they easily find themselves in an asocial company, become alcoholic, and take part in hooligan actions. But in these groups they remain strangers, passive observers or executors of someone else's will. They are coldly hostile with relatives, they abandon their studies and work, they like to leave home for a long time, they can drink and use drugs alone, but even with intensive use, physical dependence on various substances is formed weaker.

With similarities to hysterical psychopathy, the patient constantly plays the same role (“superman”, “talent”, coquette, etc.) without taking into account the situation and the impressions of others. There is no subtle artistry inherent in tantrums, the ability to assess the situation. But on the other hand, exaggerated grimaces, antics, mannerisms are expressed, combined with cold indifference to loved ones, with pathological jealousy, there is a tendency to ridiculous fantasy.

II. paranoid schizophrenia(paranoia) - according to ICD-10 "delusional disorder".

At the beginning of the disease, monothematic delirium is characteristic (invention, jealousy, litigation), which is soon joined by delusions of persecution and grandeur. All kinds of delusions are combined into a single complex ("I am persecuted for all my exceptional talents"). Hallucinations are absent, but may be delusional delusions.

The disease begins gradually, usually at the age of 30-40 years, often manifested under the influence of mental trauma. Delusion takes weeks and months to form and persists for many years. During periods of exacerbation, patients begin to migrate, fleeing from "persecutors", they can become dangerous to others, turning into "persecuted pursuers." In such situations, driven to despair, they can kill an "unfaithful wife" or an imaginary enemy.

Unlike paranoid schizophrenia, delusions outwardly look plausible based on real events, real conflicts, and the very likely actions and words of others. When evaluating paranoid ideas as delusional, one should especially carefully check whether these ideas are the product of individual creativity or the subculture to which the patient belongs. Particular care must be taken in diagnosing paranoia in cases of reformist delusions. The persistently proposed projects for the restructuring of society should not be interpreted as delusional, even if they are the product of individual creativity. The criterion for delirium is a clear contradiction to common sense, for example, a proposal to imprison all alcoholics in concentration camps, or to close all schools and transfer all students to home schooling.

III. Febrile schizophrenia- "fatal" - (hypertoxic schizophrenia, in the old manuals - "acute delirium") was isolated in the 30s thanks to the work of E.K. Krasnushkina, T.I. Yudina, K Stander, K Scheid. Occurs in recurrent and paroxysmal-progredient schizophrenia. Recognizing it is extremely important, because. this condition poses a threat to the life of patients. Even with treatment, mortality reaches 20%. The onset is sudden, the disease develops in 1-2 days. A catatonic-oneiric state develops with a predominance of stupor, alternating with periods of motor excitation. With the deepening of disorders, an amental-like state and hyperkinetic excitation with choreiform hyperkinesis are observed.

The somatic condition of patients is severe: the temperature rises from subfebrile to 40 ° and above. The temperature curve is not typical for any somatic or infectious diseases and is quite recognizable - the temperature in the morning is higher than in the evening. The appearance of patients is typical: feverish shine of the eyes, dry parched lips covered with hemorrhagic crusts, hyperemia of the skin; possible herpes, bruising on the body, spontaneous nosebleeds. Pathological reactions of the cardiovascular system are noted; weakening of cardiac activity with a drop in blood pressure, an accelerated weak pulse. Frequent collapses. Blood reactions are nonspecific: leukocytosis, lymphopenia, toxic granularity of leukocytes, increased ESR. Protein, erythrocytes, hyaline or granular casts are found in the urine. The greatest increase in temperature falls on the period of amental-like and hyperkinetic excitation. Death can occur from heart failure (sometimes against the background of small-focal pneumonia) in the stage of amental-like or hyperkinetic excitation during the transition to a coma; from the growth of autointoxication and the phenomena of cerebral edema.

IV. Attack-like schizophrenia, acute polymorphic schizophrenia, (acute polymorphic syndrome with paroxysmal schizophrenia, according to ICD-10 - "acute polymorphic mental disorder with symptoms of schizophrenia", according to the American classification - "schizophreniform disorder") - develops within several days and lasts for several weeks. Against the background of insomnia, anxiety, confusion, misunderstanding of what is happening, extreme emotional lability manifests itself: for no reason, fear alternates with euphoric ecstasy, crying and complaints - with malicious aggression. Occasionally there are hallucinations (often auditory, verbal), pseudohallucinations (“voice inside the head”), mental automatisms (“thoughts made by someone”, the sound of one’s own thoughts in the head with the feeling that they are heard by everyone - the openness of thoughts). Olfactory hallucinations are present and are distinguished by unusual odors ("smells of radioactive dust") or bizarre designations ("blue-green odors").

Crazy statements are fragmentary, not systematized, one crazy idea replaces another, is forgotten. Delusional statements are usually provoked by the situation: if blood is taken from a patient, "they want to infect him with AIDS, release all the blood, kill him." The delusion of staging is especially characteristic: the hospital is mistaken for a prison, where "everyone pretends to be sick." Often a symbolic interpretation of everything that happens (the patient was put on a bed in the corner - this means that in life he is "driven into a corner").

In many cases, even without treatment, an attack of acute polymorphic schizophrenia ends in recovery. In this regard, there is an opinion that the diagnosis of schizophrenia in such cases should be made if the psychosis drags on for several months.

V. Schizoaffective psychoses(recurrent, periodic, circular schizophrenia, atypical affective psychosis) - occupy an intermediate position between schizophrenia and manic-depressive psychosis. Therefore, these psychoses are considered either as a form of schizophrenia, or as an atypical affective psychosis, or as a combination of them, or as a special mental illness. It manifests itself in depressive and manic phases with an atypical picture. Between the phases there are light intervals (intermissions), often with a practical recovery after the first phases, but with signs of a growing schizophrenic defect as they recur.

Atypical manic phases- are characterized by the fact that in addition to an increase in mood, motor speech excitement, ideas of greatness, delusions of persecution of a "large scale" usually unfold. The delusion of grandeur itself becomes absurd, it can be intertwined with the "active" delusion of influence. In this case, patients claim that they can affect other people in some way. The delirium of the relationship takes on a euphoric coloring. There are auditory hallucinations that give advice, teach, threaten.

The phenomena of mental automatism are manifested by an unpleasant influx of thoughts in the head, a feeling that the brain works like a computer or a "transmitter of thoughts". The delirium of staging is characteristic: patients believe that everyone around has changed clothes, they are playing the roles assigned to them, everywhere “something is happening”, “moving films are going on”.

Atypical depressive phases- are distinguished not so much by melancholy and depression as by anxiety and fear. Patients cannot even understand what they are afraid of (“vital fear”), or they are waiting for some terrible events, catastrophes, natural disasters. Delusions of persecution easily arise, which can be combined with delusions of self-blame and attitude (“because of terrible behavior, his relatives will be dealt with”, everyone looks at the patient, “because stupidity is visible on the face”).

A depressive coloration is acquired by the delusion of influence (“they create a void in the head”, “deprive of sexual potency”), the delusion of staging (secret agents and provocateurs disguised all around to bring the patient under arrest), derealization (“everything around is as lifeless”) and depersonalization (“ became as if inanimate). There may be hallucinations (auditory) described in paranoid schizophrenia (threats, accusations, orders).

mixed states: especially characteristic of repeated phases. Depression and manic symptoms coexist at the same time. Patients are excited, angry, active and tend to command everyone and participate in everything. At the same time, they complain of boredom, sometimes of melancholy and unreasonable anxiety. Their statements and emotional coloring often do not correspond to each other. With a cheerful look, they can say that they were infected with syphilis, and with a dreary expression that their head is full of brilliant thoughts.

Oneiroid states: often develop at the height of manic phases, less often depressive. The picture corresponds to the oneiroid catatonia described above.

The duration of all types of phases is different - from several days to several months. Light intervals are varied in duration. Sometimes one phase replaces another, sometimes many years pass between them.

Statistics indicate that more and more modern people are beginning to suffer from schizophrenia. This is due to the reasons that lead to various forms of the disease. The symptoms appear brightly, so relatives, who will have to take care of a sick person, will need to seek medical treatment.

It is not a mild disease that can be cured in a couple of days. In clinical practice, people remain schizophrenics forever. There is no treatment that can cure a seriously ill schizophrenic, but there is a therapy that alleviates his condition.

The Internet magazine site speaks of a chronic disease that makes a person disabled, unable to live in society and adequately perceive the world around him. Schizophrenia usually appears during adolescence.

What is schizophrenia?

Schizophrenia is a psychotic illness that mainly affects mental loss and emotional distortion. This disorder is characterized by inadequate and reduced affect (emotional reaction), disorder of thinking and perception. Often all this is accompanied by hallucinations (fantastic and auditory), paranoid delusions, disorganization of speech, activity and thinking.

Is it possible to say that the disease affects men or women more? In fact, both sexes become schizophrenics, only in the case of women, the disease manifests itself a little later.

The schizophrenic in the truest sense of the word is no longer part of a healthy society. He cannot do work, even serve himself. However, we are talking about a chronic disease that has remissions, that is, periods when the symptoms subside and the person seems to be completely healthy. During such periods, he can begin to do something and even think sensibly. However, one should not hope for a miracle. Schizophrenia is progressive in nature, which entails an increase in the period of exacerbation of symptoms.

Schizophrenia is understood as a whole complex of symptoms, since the disease itself manifests itself in various forms. This sometimes causes debate about the allocation of individual diseases from a single schizophrenia. In the common people, schizophrenia is called a split personality, although in reality a person can have many personalities.

A schizophrenic cannot adequately respond to the world around him, therefore he often shows not quite adequate behavior. A split personality occurs, apathy and emotional fatigue develop, connections with other people are lost. It is easy enough to recognize a schizophrenic in another person, since his behavior is not characteristic of an ordinary person.

However, mention should be made of the various stages and forms of schizophrenia, which mislead people who then find out that they were friends or built love relationships with schizophrenics. In fact, not all people are diagnosed, and some continue to be part of the social environment, but their behavior is not immediately suspicious.

Forms of schizophrenia

Schizophrenia has many faces, just like the person who suffers from it. It distinguishes several forms, the classification of which we consider below:

1. Schneider classification:

• the influence of external forces.
• The sound of one's own thoughts or the feeling that other people are hearing the person's thoughts.
• Voices that comment on the actions or thoughts of the patient or talk among themselves.

1. Downstream classification:

• A simple - imperceptible, but progressive form of the disease, in which oddities in behavior that do not meet the rules of society begin to appear, and a decrease in activity. There are no acute episodes of psychosis.
• Disorganized catatonic - the disease manifests itself at the level of psychomotor, when the patient is either in a stupor, or begins to actively move (excited). The patient is susceptible to negativism and automatic submission. Behavior becomes bizarre. There are vivid visual hallucinations and clouding of consciousness in a dream.
• Paranoid - delusions are combined with auditory hallucinations. At the same time, the volitional and emotional spheres are practically not violated.
• Residual (residual) - a chronic form of schizophrenia with the following symptoms: decreased activity, psychomotor retardation, passivity, lack of initiative, dulling of emotions, poverty of speech, impaired will.
• Hebephrenic - develops in adolescence, when emotional affects become superficial and inadequate. The patient's behavior becomes unpredictable, mannered and pretentious, delusions and hallucinations are fragmentary, will and emotions are flattened, the symptoms of the disease become vivid.

1. According to ICD:

• Post-schizophrenic depression.
• Simple schizophrenia.

1. By the nature of the flow:

• Continuously - the symptomatology grows, passes without remission. She happens:

1. Hebephrenic, or malignant, is gaining momentum in adolescence, but in childhood it manifests itself in a decrease in academic performance and development.
2. Low-progressive, or sluggish - develops over many years, manifests itself in adolescence, gradually disintegrates the personality. Accompanied by psychopathic and neurosis-like disorders.

• Paroxysmal - periods of remission are present. It is this form that is often confused with manic-depressive disorder. It happens:

1. Paroxysmal-progredient - the first attack is short, followed by a long remission. Each subsequent attack is long and bright, which worsens the patient's well-being.
2. Recurrent, or periodic, - manifests itself in the form of schizoaffective psychosis with prolonged attacks. It appears at any age. The complete perception of everything that surrounds is disturbed.

From schizophrenia, the following diseases should be distinguished:

1. Schizophreniform psychosis is a mild mental illness. Individual symptoms of schizophrenia appear, which are additional, and not basic. Hallucinations and delusions predominate here.
2. Schizotypal disorder is a disorder of emotions and thinking, eccentric behavior that is similar to schizophrenia. It is difficult to detect the onset of the disease.
3. Schizoaffective disorder is a combination of affective disorder with schizophrenic symptoms. There are manic, depressive and mixed types.

Why does schizophrenia develop?

To date, psychologists cannot name the exact causes of the development of such a terrible disease as schizophrenia. However, they give a list of reasons that may contribute to its development, but not in all cases:

• Heredity. If there is a schizophrenic in the parents' family, then the child may also develop the disease in 10% of cases. In identical twins, if the disease is detected in at least one of the children, the risk of developing schizophrenia in the second child increases to 65%.
• Upbringing. This reason is considered a hypothesis that with little attention from parents to the child, he develops schizophrenia.
• The impact of infection on the development of the baby in the prenatal period.
• Bad habits. Alcohol and drugs, of course, cannot cause schizophrenia, but they increase the symptoms when consumed. Amphetamines, hallucinogenic and stimulant drugs negatively affect a person.
• social factors. These include unemployment, poverty, frequent moving, conflicts in society (wars), hunger. According to some scientists, these factors can either develop a mild form of schizophrenia or exacerbate the symptoms of an existing disease.
• Disruption of connections in the brain. This theory is based on disruption of the work of neurotransmitters, which can also be observed in the prenatal period.

How to recognize schizophrenia?

It seems to many that it is difficult to recognize schizophrenia. However, this is observed only in the initial stages of the disease. If schizophrenia has already gained momentum, then it is easy to recognize.

At the beginning of its development, symptoms may be blurred or absent altogether. This is why schizophrenia seems to be difficult to detect. Some of her symptoms are simply ignored, considered insignificant. However, later, when the disease has reached the peak of its development, all the signs appear:

1. In adults:

• Voices in my head.
• Rave.
• Ideas that do not have a semantic load.
• Feeling that the patient is being watched from the side.
• Lack of emotion.
• Withdrawal from social life.
• Lack of pleasure from anything.
• Arbitrary self-isolation.
• Disorder of memory and thinking.
• Lack of self care.
• Difficulties in processing even primitive information.
• depressive states.
• Mood swings.
• In men: self-isolation, voices in the head, persecution mania, aggressiveness.
• In women: persecution mania, delusions, frequent reflection, conflicts based on social interests, hallucinations.

1. In children (detected from 2 years of age):

• Irritability.
• Rave.
• Motility disorder.

1. For teenagers:

• Aggressiveness.
• Poor progress.
• Closure.

Dementia is a symptom of severe schizophrenia.

How is schizophrenia diagnosed?

Schizophrenia can only be diagnosed by a specialist in the field of psychiatry. He collects the complaints of the patient himself and his close circle, and also observes the behavior. It is remarkable how the schizophrenic thinks and sees the world. At each stage of his illness, the world seems to a person completely different.

The main thing to distinguish schizophrenia from other diseases of the mental class, as well as determine the severity.

How to treat schizophrenia?

Schizophrenia can only be treated by a psychiatrist who prescribes an individual course of antipsychotics, nootropics, mood stabilizers, and vitamins.

What are the prognoses for schizophrenia?

There is no hope that schizophrenia can be cured. The origins of its development are unknown, and its appearance is often explained by a predisposition or malfunction of the brain. Forecasts are always more or less favorable, which depends solely on the stage of the disease and how the patient feels as a result of treatment.