Schizophrenia is called "the disease of our time". Indeed it is mental disorder is now much more widespread than in any of the historical eras known to us.

But few people understand who a schizophrenic is, how he differs from healthy person.

Of course make a diagnosis, including this one, can only be done by a specialist. But there are a number of features that distinguish such patients that any person can identify.

What is low-grade schizophrenia? Find out about this from ours.

What is "schizophrenia"?

Schizophrenia- one of the three (along with hysteria) main mental pathologies.

Its essence– in breaking the patient’s connections with the world, other people and even himself.

“Schizo” in ancient Greek means “to split” or “to break off a piece.” “Frenos” - “head”, in a figurative sense - “brain”, “thinking”, “soul”.

One of the most talented books about schizophrenia, written by the English psychiatrist Ronald Lang, is called “The Shattered Self.”

A person feels healthy and complete only when he is connected with other people, the world, is in contact and in a certain harmony with himself (with his inner world). Schizophrenia occurs due to the lack of these connections.

Such an internal state is extremely painful for the patient himself, interferes with his socialization, and is sometimes accompanied by painful symptoms associated with physical suffering can make it dangerous to others.

Who is a schizophrenic? Who is being given this label unjustifiably? Psychologist answers:

Psychology: how do they see the world?

Ronald Lang believes that the most important psychological feature such patients are "ontological uncertainty". Every person faces a number of challenges in life.

He must find his place among other people, understand what he is like, what he represents, establish certain relationships with people, decide who he likes and who he doesn’t, find his own business and achieve something in it, form his own worldview, become an adult, responsible person.

Faced with these problems, prone to schizophrenia or already sick man folds, refuses to solve them.

"Ontological" uncertainty– this is uncertainty when solving the main problem of our life: self-identification, finding oneself, creating oneself.

“The main passion of a person is to be, to be fulfilled, to be fulfilled as a person,” said the philosopher Merab Mamardashvili.

A psychopath is afraid to become a person, a person, an individual. He's afraid to happen. He avoids solving this problem. Sometimes he does this because avoiding the problem seems to him the best solution to this problem.

Sometimes he seems too weak and insignificant, unable to solve it, and therefore avoids her. Sometimes he is afraid that some evil forces, people or social structures those who have power over him will punish him if he becomes a person. However, in any case, as a result he gets sick.

The core of his pathology is fear of the world and life. Since he himself feels weak, powerless, the world and other people seem to him to be completely separated from him, alien and even hostile, capable of “gobbling up” and absorbing him.

He is also afraid of himself, that is, he is afraid to look inside himself, to understand what he really is. It is this—genuine contact with oneself—that the patient fears most.

Psychiatrists call the lack of contact with your inner world "aleksithemia". Each of us understands ourselves with varying degrees of accuracy and objectivity, but we know what we feel in at the moment and what you felt before, at key moments in your life; we know what we want, what we are striving for.

Although we may make mistakes in the interpretation of our motives, we may not understand the origin of some of our emotions.

However, such misunderstanding is within the normal range. Schizophrenic knows almost nothing about himself.

He often speaks biasedly even about his appearance. He does not know his true feelings and desires. Instead, he names fantastic, often absurd, desires and experiences. He also attributes imaginary qualities and aspirations to other people.

That is, a characteristic feature of a schizophrenic is existence in a fantasy world, created by himself, but accepted by him as real. He is terribly afraid of the real world, with its demands and tasks, and avoids it in every possible way.

How to recognize schizophrenia? Psychologist's advice:

Can a great man be sick?

Many outstanding people were and are called schizophrenics. Now, for example, this is what they say about Grigory Perelman, genius Russian mathematician.

It is known that he does not communicate with people at all, even with colleagues, he has lived his entire life with his mother (he is 51 years old), without trying to get married, often expresses incomprehensible, paradoxical thoughts, and is extremely ascetic in everyday life.

The same pathology was attributed, on the basis of some symptoms, Nikolai Gogol, Isaac Newton, Vincent van Gogh, Ernst Hemingway, Franz Kafka and many other wonderful people.

In this regard, the following should be noted.

The diagnosis is made not by public opinion, not by the media, but by a doctor. None of these people had or have a documented psychiatric diagnosis.

“Schizos” are often called people with strange, unusual, incomprehensible behavior. And among the talented creative people there are really a lot of them. However, this does not mean that they are psychopaths.

In a certain sense, the closest thing to psychopathy is the ordinary European man in the street, who is sure that he is normal, but Hemingway was a psycho.

In fact, the writer was especially sensitive, subtle, vulnerable person with a pessimistic worldview, however, he was distinguished by excellent performance and activity, was extremely sociable, and had hundreds of friends and acquaintances. He was a much healthier person than those who consider him sick.

At the same time, a creative person can also get sick. However, we have the right to assert that the percentage of psychopaths and those prone to psychopathy among such people is much lower than among those who are not engaged in creative work.

Obviously, creativity itself is good “cure” for this disease.

Is schizophrenia inherited? find out right now.

Symptoms and signs of the disease

Ronald Lang believes that a schizophrenic is afraid of certainty. He wants to appear (including and even mainly to himself) mysterious, incomprehensible, incomprehensible.

Example: in the famous children's fairy tale by Lyman Frank Baum “The Wizard of Oz” (known in our country as “The Wizard of the Emerald City”, translated by A. Volkov), the charlatan Goodwin acts.

This small, weak and insignificant a man who managed to become the ruler of the Emerald City.

He never appears in public except under various masks, depicting him in the form of terrible animals or magical creatures.

His city itself is ordinary, but all residents and guests, on pain of death, are ordered to wear green glasses without taking them off, which is why it appears “emerald.” Although Goodwin is a fictional literary character, he has obvious symptoms of schizophrenia.

One girl, sick with this disease, told everyone that she was actually born not on Earth, but on another planet, that she remembers her home planet well, and only there, on this planet, could she become what she is on actually.

Such strange ideas, in which the patient himself unconditionally believes, very characteristic of this pathology(they are often called “schizophrenic delusions”). The reasoning of patients is characterized by illogicality, absurdity, or very strange logic.

Thus, one adult patient, 35 years old, who at the age of 22 married a man who sincerely loved her and, as it seemed to her, loved her, but immediately after the wedding ran away from her husband to her mother and stayed to live with her, when asked by the doctor why she left her husband, she replied that she could not help but leave her husband because he did not satisfy her sexually.

The doctor asked the patient in detail about her sex life, found out that it was stormy and varied, and had faded in recent years, but the only example of normality in her entire life was her relationship with her husband.

But the most curious thing is that the patient left her husband for her mother, and not to another man. And he has been living with her ever since.

That is, a normal intimate relationship with her husband did not satisfy her, so she decided to live with her mother and not have permanent intimate relationships at all.

Let's imagine a person who bought a beautiful apartment in Moscow, lived there for a month, and then left, leaving the apartment and settling in Yakutia, and when asked why he didn’t want to live in Moscow, he answered: “It’s too cold there.”

But Yakutia is a pole of cold. Moscow, in comparison, is a very warm place. Such strange logic is typical for these patients.

When communicating with such a patient, a feeling of closedness and non-contact is created. He doesn't answer any questions directly. His lines are not logically related to each other, nor with the interlocutor’s remarks.

Patients are withdrawn and often refuse to communicate at all. They don’t like to make independent decisions and avoid them.

Patients are characterized by passivity, inaction, often even physical. Sometimes it all ends when the patient lies for days and weeks without getting up, in one position, losing the ability to control his body.

Patients tend to obsessive states: recurring dreams or visions, strange, recurring thoughts.

Let's say one sick woman often saw herself in a dream in some city, which, in her opinion, was Moscow(although at the time when she saw this dream for the first time, she had never been to Moscow).

She always ended up there on the same street, where she was supposed to find a woman named Sophia. She didn’t know her address, her last name, or her appearance. I also didn’t understand why she needed this Sophia.

Despite this, the desire to find this Sophia at any cost forced her several times to buy tickets to Moscow, walk around the huge city in search of that very street, but, p, she did not find either the street, or, especially, the mysterious Sophia .

The patient's speech often gives the impression strange, confusing, illogical.

He can forget ordinary words, but at the same time come up with words that are not in the language.

Patients often have unclear handwriting, which they themselves cannot make out, and this is not the result of negligence: they write diligently and even beautifully, but in such a way that nothing can be understood.

Why don't schizophrenics sleep? As with many other pathologies, with schizophrenia it is possible sleep disorder.

Sometimes the patient is afraid to fall asleep, because he is sure that it is in his sleep that some kind of catastrophe can happen to him, which he will not be able to prevent.

In relationships with people, schizoid psychopaths exhibit aloofness and wariness, avoid close (both spiritually and often physically) relationships, are unable to love and become attached, do not experience feelings characteristic of normal people (for example, they are not upset by the death of loved ones).

They avoid informal contacts, never look their interlocutor in the eyes, because they are afraid to be truly understood, seen and recognized for who they really are.

How to distinguish from normal people?

This question worries many. The fact is that psychopaths many consider them dangerous people. This is wrong. These are the same people who need help. How do schizophrenics behave?

There is no method by which one can reliably distinguish a schizoid psychopath from a healthy person. Even experts sometimes find it difficult to do this.

Modern Consumer Society inherently schizoid. It seems to be organized specifically in such a way as to provoke as much as possible more cases of schizophrenia.

He himself is in front of unusual, mentally unhealthy people. symptom of schizoidity. Therefore, it is better not to try to make a diagnosis yourself. If you suspect that you are sick or that someone close to you is sick, contact your doctor.

How to get rid of panic attacks? you will find on our website.

Causes and provoking factors

Ronald Lang considers the main such factor requirement of absolute obedience presented by his parents. In fact, parents demand: “Don't be yourself. Be our doll, our toy, which we will manipulate as we please.”

Another unfavorable factor is loneliness.

If no one loves a child, he is not the only one in the world for anyone, he may end up getting sick.

Contribute to this disease alienated relationships with people, in which there is no genuine interest in each other: people communicate purely functionally, seeing each other not as an end, but only as a means to achieve some alienated goals.

How to communicate with a schizophrenic and how to help him?

How to deal with a schizophrenic in the family? How to talk to him? You need to communicate with such a person exactly the same as with a healthy person. At the same time, not forgetting that you are dealing with a patient. That is, it is good to control yourself, if possible, not to be surprised by anything.

Under no circumstances should you become irritated, shout, or be aggressive. You cannot intrusively invade the inner world or territory of such a person, for example, enter his room without knocking, even if it is a small child.

At the same time, you cannot indulge him in everything, you cannot allow him everything, on the grounds that he is not like everyone else. Help a schizophrenic even the most best doctor. If you want to treat exacerbations, you need to follow the doctor’s recommendations: they are always individual.

Can he live alone?

In a sense, all schizoid psychopaths lonely, internally alone. However, not all of them can serve themselves. It all depends on the stage of the disease.

If it is deep enough, the patient may stop eating (refusal to eat is also one of the symptoms of this pathology; for example, N.V. Gogol died for this reason) and die.

How to understand that you are schizophrenic? Can the patient himself understand that he is sick? Yes, sure. Among schizoids a lot very smart people . The problem is not the inability, but the unwillingness to understand oneself. Which is often characteristic of mentally healthy people.

How long do schizophrenics live? There are no exact statistics.

It can definitely be said that schizophrenics live, on average, one and a half to two times less than healthy people.

This is due to their refusal to develop, loss of a sense of meaningfulness in life, lack of communication and cheerfulness.

Their state of mind provokes the appearance of a number of somatic disorders (cancer, for example), often - already at an early age. However, many schizophrenics live as long as healthy people.

Schizophrenia is truly the “disease of the century.” This is also why we need to learn to treat schizoid psychopaths with understanding and compassion. They are sick, but they are people.

They paint themselves into a corner, but they do it unconsciously. We can only help them if we see in them, first of all, people just like ourselves.

Schizophrenia is the most mysterious and little-studied pathology. A complex, severe mental disorder destroys human essence, negatively affecting the ability to think, speak, and perceive reality. The name “schizophrenia” was first used by Swiss psychiatrist Eugen Bleier in 1909.

Before this, the pathology was classified as a type of dementia (dementia). Bleier, for the first time in the psychiatric world, explained what schizophrenia is and proved that its feature is not cognitive impairment (decreased thinking and mental functions), but a complete collapse of a person’s mental makeup.

Schizophrenia is a severe mental disorder

The word "schizophrenia" is of Greek origin and means "to split the mind." This is an endogenous disorder (that is, arising not through external, but through internal mechanisms, where genetic predisposition plays a large role).

Schizophrenia, what is it, according to Eugen Bleier. The scientist classified the disorder as a combined set of “four As”:

1. Autism. Fenced off, disconnected from the surrounding reality. One of the main symptoms of pathology.
2. Affect. A powerful emotional shock that occurs due to the inability of the individual to escape from critical situations.
3. Ambivalence. Splitting of consciousness, dual perception and attitude towards something (when one object evokes opposite feelings in a person at the same time).
4. Associative thinking. The presence in a person of a certain thought process, during which various images appear in the mind, concretizing a certain situation.

Schizophrenia is very often accompanied by alcoholism, drug addiction, severe depressive disorders. Contrary to popular belief, not many people suffer from severe mental illness. Large-scale studies show that the disorder is diagnosed in 0.4-0.6% of the population.

Residents are more at risk of contracting the disease major cities. The peak of the disease has age-related characteristics:

• men: 22-30 years old;
• women: 25-33 years.

It has been noted that the disease rarely affects older people and young children. Schizophrenic disorder carries with it profound social problems, up to complete disadaptation of the individual (loss of socialization). Disadaptation brings with it homelessness, unemployment and constant thoughts of suicide.

How the disease develops

The essence of the disorder and the definition of schizophrenia is the inability of the individual to adequately perceive reality. The patient’s surrounding world includes facts, sounds, smells, actions, and situations scattered into small components. A sick person adds his own illusions, creating an unimaginable, non-existent reality.

Comparison of the brain of a patient with schizophrenia and a healthy person (on the left is the brain of a healthy person, on the right is the patient’s)

The patient is unable to fit the processes that occur in the inflamed brain into any framework or rules. Schizophrenics react to the quirks of their own brain with inadequate reactions, sometimes reaching the point of a seizure. Doctors were unable to determine exactly how the pathology develops.

The most likely version is the following development of events:

1. In certain areas of the brain, specific hormones (serotonin, dopamine) begin to be produced in large quantities.
2. Excess hormones provoke an acceleration of lipid peroxidation. That is, oxygen oxidation of fats that make up cellular tissue occurs, which accelerates the death of brain cells.
3. Due to the global destruction of brain cells, disruptions begin in the blood-brain barrier (the membrane that prevents contact between the brain and blood).
4. There is an accumulation of debris from dead cells, which leads to the development of an autoimmune conflict. Autointoxication begins (poisoning of the body with the breakdown products of its own substances, when the body’s immune system begins to fight the body’s cells).
5. Such processes lead to the persistent formation of a focus of constant excitation in the cerebral cortex. Prolonged irritation of weakened cells provokes the development of auditory and visual hallucinations, delusional ideas characteristic of the patient.

The brain requires a lot of energy to fuel the focus of excitation. As a result, the body is deprived of necessary nutrients other brain areas. This leads to the gradual destruction of the ability to think and reason adequately. Memory, attention, emotions, and will suffer.

What causes pathology

Most experts are inclined to believe that schizophrenia is a multifactorial disease. Pathology develops due to the complex influence of exogenous (external) and endogenous (internal) factors on the body.

Schizophrenia is hereditary. The risk of developing the disorder increases 25 times if a family member is diagnosed with schizophrenia.

It is noted that there are more schizophrenics among people born in the summer and spring periods. Proven factors that directly influence the onset of the disorder include:

• abnormalities of brain development;
• difficult delivery;
• fetal infections during intrauterine development;
• psychological experiences at an early age;
• long-term use psychoactive substances, drugs, alcohol.

Clinical symptoms

The onset of the disease is represented by a specific period, which is called the “premorbid phase”. Its duration varies between 1-2 years. This time is marked by the development of the following nonspecific symptoms in the individual:

• constant irritability;
• sharpening of inherent character traits;
• bizarre, unusual behavior;
• decreased need to communicate with other people, withdrawal into oneself;
• the appearance of dysphoria (painfully gloomy mood, hostility towards others).

The premorbid phase gradually develops into another period - the prodrome, preceding the onset of the disease. At this time, the person completely withdraws from others, and severe absent-mindedness develops.

Clinical signs relapse disorder

In the premorbid phase, symptoms of schizophrenia become psychotic. Short-term disorders develop. Then a full-blown psychosis develops, leading to illness.

Doctors divide all symptoms of schizophrenia into two main categories. Let's take a closer look at them.

Positive symptoms

These are signs that are “added” to a person, such that were not previously observed (in a healthy state). These include:

Hallucinations. Schizophrenia is most often marked by auditory hallucinations. The patient feels that non-existent voices are sounding in his brain or are trying to capture his attention, sounding from the outside, from various foreign objects.

There are cases when a schizophrenic simultaneously heard 2-3 voices, which also argued among themselves.

In addition to auditory hallucinations, tactile hallucinations are also added (the patient thinks that something is happening to him). For example, ants biting the skin, fish in the stomach causing pain, slimy toads in the hair. Visual hallucinations in schizophrenic disorder are very rare.

Rave. It seems to the patient that some enemy otherworldly force is powerfully acting on his psyche and subconscious, pushing him to carry out certain actions. The influence (according to patients) occurs through the method of hypnosis, some technical forces, witchcraft, telepathy. Doctors note other delusional signs of schizophrenia:

• persecution (the patient feels that he is being followed, being watched);
• self-accusation (the patient considers himself guilty of death, misfortunes, illnesses of relatives and friends);
• hypochondria (there is a strong belief that the person has a serious, incurable disease);
• jealousy (the sick spouse develops a strong belief in the infidelity of the other half);
• greatness (a person is convinced of the presence of supernatural abilities or unconditionally believes that he occupies a high position in society);
• dysmorphic (a schizophrenic is confident in personal ugliness, the presence of a non-existent deformity, the absence of a body part, gross scars, defects).

Obsessions. In the consciousness of a sick person, thoughts and ideas of an abstract orientation are constantly present. They are global and large-scale in nature. For example, a person constantly thinks about the collision of the earth with an asteroid, the fall of the Moon on the planet, the explosion of the Sun, etc.

Mechanism of development of schizophrenia

Movement disorder. Such symptoms appear as:

1. Catatonic excitement. Inadequate state in the form of psychomotor restlessness: foolishness, pretentiousness of speech, arrogance, exaltation.
2. Catatonic stupor. Decreased psychomotor activity. Being in this state, the patient becomes completely immobilized, the muscles of the body tense greatly, freezing in an elaborate and unusual position.

Speech disorders. People suffering from schizophrenia engage in lengthy and meaningless spatial reasoning. Their speech is filled with numerous neologisms and overly detailed descriptions. Schizophrenics in a conversation quickly jump from the current topic to another reasoning.

Negative symptoms

Such symptoms are classified as degradative - the person’s skills and abilities that were there before (when the person was healthy) disappear. These are the following disorders:

Emotional. The patient experiences a noticeable depletion of emotions, and there is a prolonged deterioration in mood (hypotymia). The number of contacts is sharply reduced, a person strives for privacy, and ceases to be interested in the wishes of his relatives. Schizophrenia gradually leads to complete social isolation.

Strong-willed. Disorders in this area are manifested by the growing passivity of the individual. Patients lose the ability to make their own decisions; they live by habit, armed with memories of their own habitual behavior, or copy the behavioral reactions of others.

At the onset of the disease, many people experience attacks of hyperbulia (increased libido and appetite).

This can lead to the development of antisocial behavior: illegal actions, alcoholism, drug addiction. At the same time, the patient does not get pleasure and cannot form a personal attitude towards situations.

The needs of a schizophrenic are significantly reduced, intimate attraction disappears, and the circle of common interests narrows. Gradually, patients begin to forget about hygiene and refuse to eat.

Classification of schizophrenia

Based on the manifestation of certain symptoms, pathology is divided into five main types:

1. Catatonic. The disease progresses with a predominance of various psychomotor disorders.
2. Residual. Schizophrenia is marked by mild symptoms related to positive factors.
3. Disorganized (or hebephrenic). It manifests itself as an impoverishment of the emotional component of the personality and a pronounced disorder of thinking.
4. Undifferentiated. It is characterized by an increase in psychotic symptoms, while undifferentiated schizophrenia does not fit into the picture of other types of illness.
5. Paranoid. Delusions and obsessive hallucinations are observed. Emotions do not suffer, unlike the ability to think and behave, which are clearly impaired.

In addition to the main classification of pathology, psychiatrists distinguish two more categories of disease (according to the ICD-10 classification):

1. Schizophrenia simple type with gradual personality regression and the absence of acute psychoses.
2. Post-schizophrenic depressive state. It is characterized by a steady decline in emotional qualities.

Russian psychiatrists also have a gradation of the disease according to the nuances of its course:

• sluggish;
• continuously flowing;
• periodic (recurrent);
• paroxysmal (fur-like).

This variety of gradations of the disease helps doctors more accurately develop drug therapy and give a prognosis for the development of pathology.

Treatment of the disease

Therapy for schizophrenia takes a comprehensive approach, including the following types of treatment:

Medication. basis pharmacological treatment becomes the use of medications with antipsychotropic effects. Preference is given to atypical antipsychotics. To stop the development of side effects, antipsychotics are combined with drugs from the benzodiazepane group and mood stabilizers.

If medications are ineffective, psychiatrists prescribe ICT (insulinocomatose therapy) and ECT (electroconvulsive therapy).

Psychocorrection. The main goal of psychotherapy is to restore the patient’s cognitive skills and improve his socialization. Psychiatrists work on the patient’s awareness of his own characteristics. Family therapy becomes effective; it is needed to create a favorable climate in the patient’s home environment.

Treatment goals for schizophrenia

Disease prognosis

The final result of treatment is influenced by many factors: the gender of the patient, the age at which the disease began, the characteristics of the onset, the type and form of the disease. According to statistics, the pathology prognosis is as follows:

1. In approximately 40-45% of cases, the appearance of stable remission in the patient's condition is noted. The patient can return to work and lead a normal life.
2. In 55-60% of schizophrenia develops into sluggish chronic form, manifested by moderate disorders. The quality of life of people is still decreasing, but it is within the psychological comfort zone.

We can talk about remission when signs of the disorder are not observed for six months. But this does not mean that the patient has recovered. In the case of schizophrenia, unfortunately, about full recovery you can't talk. The patient's condition can only be significantly improved and the person returned to normal life.

Schizophrenia is a chronic and severe mental disorder, often leading to disability. Until now, psychiatrists cannot find out the true cause of this disease, despite many years of research. Hereditary predisposition plays a leading role. Head injuries, mental trauma and past illnesses are of secondary importance, acting as an activator of the process of psychopathology. Schizophrenia is characterized by gradually increasing changes in thinking and perception, speech and social activity, motivations and feelings. Most often, the disease occurs at the age of 15-25 years and has a progressive course. The schizophrenic seems to be on the other side of evil and good, changing the rules of the game of life. He avoids communicating with people, preferring to talk to himself; the meanings of words change arbitrarily. The patient's quirkiness often irritates those around him. He may laugh merrily when he learns of his death loved one. Sometimes patients recklessly risk their lives, refusing to drink and eat, and sexual activity is almost invisible and sometimes inadequate. Also in motor activity, it may include strange actions and obsessive gestures, catatonic stupor (that is, a person remains motionless for a long time and in an unnatural position). Unique crazy ideas- an integral attribute of a patient with schizophrenia, this can be a topic of physical, fatal disease, special mission or . The most characteristic and interesting symptom of this disease is a distortion of the perception of reality. The patient may actually feel as if his mouth is on his stomach or his bones are too light. Looking at himself from the outside, he may perceive his own person as a biomachine or identify himself with the carpet and cry out in pain when it is knocked out. In the patient’s perception, characters appear that no one else sees: angels, demons or strange animals. Primary diagnosis and further treatment The disease is dealt with by a psychiatrist. Very often, examination of the patient requires hospitalization in a psychiatric department. A definitive diagnosis is made after a duration of at least six months. If one of your family or friends suffers from this disease, do not push him away, remember that changes in personality and character are only a manifestation of the disease. Try to monitor the regularity of taking medications prescribed by your doctor. Changing the dosage or unauthorized discontinuation of drugs may lead to a worsening of the condition.

Superficial knowledge of most highly specialized areas often gives rise to rumors and stereotypes that are very different from reality. Who is a schizophrenic? Psychopath? A person with a dual personality? Monster? Not many will be able to give a correct assessment of this severe mental disorder. Let's try to talk about a complex term in simple words.

Reasons

So, what is a schizophrenic? And what is schizophrenia? Let's try to figure out what negative factors can cause such a complex problem to develop. mental illness. What influences the mind so much: genetics or, perhaps, ecology? Who is at risk?

Schizophrenia (from the Greek schizo + phren = “split mind”) is a progressive chronic mental disorder, expressed in a distorted perception of reality, impaired thinking and inappropriate behavior.

The hereditary factor, unfortunately, plays a significant role. If you believe the statistics, the presence of this diagnosis in representatives of the first degree of kinship (parents - children) determines the risk of the disease with a 10% probability. In addition, the disorder can be inherited. Approximately 60% of people suffering from this disease do not have schizophrenics in their family. The rest were less fortunate with genetics. However, transmission of a predisposition to a mental disorder from the mother does not mean 100% development of the disease. A genetic risk factor may remain in the potential category forever. So who is a schizophrenic? And what conditions, other than abnormal brain structure, cause this disease? Here are some potentially dangerous stressful situations:

Prolonged/premature labor (hypoxia);

Viral infections acquired in infancy or during embryonic development;

Stress (for example, the early loss of a parent or a difficult divorce);

Physical/sexual violence.

Signs of schizophrenia

The question of how to recognize a schizophrenic will be answered scientifically by the Bleuler tetrad, the so-called “four A’s”, clearly expressed in the patient (together or separately):

1. Ambivalence- manifestation of completely opposite opinions and feelings regarding one situation, object or subject. For example, a schizophrenic may adore and hate Orange juice, at the same time love to run and fundamentally deny this activity. Ambivalence can also be expressed in endless hesitation when making a choice.

2.Associative defect (in short, alogy)- a thinking disorder associated with a gross violation of logic when constructing reasoning or dialogue. Main features:

• stinginess (poverty) of speech;
• monosyllabic statements (small vocabulary);
• delay in responses (long pauses).

3. Autism- distraction from reality with immersion in your personal, far-fetched, inner world. This sign distinguishes closed, taciturn people with limited interests who strive for isolation. They are not able to build normal communication, and therefore practically do not interact with others.

4. Affective inadequacy- completely illogical responses to current events. For example, laughter at the sight of a dying person or bitter tears at joyful news.

The listed pathological effects allow us to understand who a schizophrenic is. Signs of the disease do not necessarily appear all at once: a combination of the two factors listed above is sufficient. The result is personality changes, unsociability, loss of interest in life.

Main symptoms

Practical psychiatry identifies three groups of symptoms of schizophrenia.

1. Positive syndromes:

• hallucinations;
• rave;
• inhibition of thinking: illogicality and confusion of thoughts, inability to complete a sentence, forgetfulness (“Why did I go there? Why did I take this object?”);
• derealization - the absence of boundaries between reality and fiction.

Let's try to clearly explain who a schizophrenic is, how to recognize him, in the presence of the last, most difficult to define syndrome. An example would be a person who is unable to personalize their own personality. He considers himself “absorbed by the world,” denies relatives and, on the contrary, insists on kinship with complete strangers.

2.Negative syndromes:

• emotional coldness (frozen facial expressions, monotony of speech);
• lethargy (difficulty maintaining a conversation, inability to make quick decisions);
• low concentration;
• loss of interest in life, replacing reality with obsessions;
• asociality: it is difficult for a person to make acquaintances, he has poor contact with others, and subsequently stops communicating even with loved ones.

3. Cognitive syndromes also allow us to understand who a schizophrenic is. Symptoms of cognitive dysfunction will help to draw a prototype of such a patient in a form sufficient for perception. Here we are talking about various disorders of attention, thinking and memory. The patient's speech is distorted: conversations become abstract, vocabulary becomes poorer. A person’s daily life is changing: social, household and professional responsibilities become difficult to fulfill.

Clinical forms of schizophrenia

The classification, which includes five classic forms of the development of the disease, will allow you to understand how a paranoid schizophrenic differs from a catatonic one:

1. Hebephrenic schizophrenia. Characteristic features of the patient are foolishness, grimacing, fussiness, and euphoria. Speech, as a rule, is broken, behavior is unpredictable. This form is characterized by the most malignant course with a very rapid development of dementia.

2. Circular. Associated with periodic attacks and mood swings: from manic (high) to depressive (low). Hallucinations and persecution delusions are not uncommon.

3. Simple. This form of schizophrenia develops slowly and begins in adolescence. Manifests itself with the described negative syndromes and episodic delusional ideas. It often proceeds malignantly, leading to the formation of a defective state and a complete change in personality.

4. Paranoid. The most common form, where the patient has ideas of persecution, jealousy, poisoning mania, hallucinations and pseudohallucinations in the foreground. The patient cannot restrain his emotions, and therefore his behavior reflects his own experiences. A paranoid schizophrenic usually develops in adulthood.

5. Catatonic. A characteristic feature is temporary immobility. Patients can lie in bed for days without speaking at all. It happens that they freeze in bizarre positions, remaining in this position for hours.

Manifestations of schizophrenia

How to recognize a schizophrenic? Here is the most alarming question among loved ones who have noticed changes in behavior dear person. Try to be careful, because obvious signs illness is hard to miss...

1. Hallucinations. They manifest themselves in the creation of a fictional world with a distorted reality. The patient has impaired perception from all senses: deceptions are visual (imaginary pictures), auditory (ephemeral voices), olfactory, gustatory and tactile.

Hallucinations are divided into true and false. In the first version of psychosis, a person “hears” sounds or “sees” images in real rooms (for example, a story about the heavenly singing of birds within the walls of his own apartment). In the second case, fictitious images are concentrated in the patient himself (for example, an assurance about snakes living in the body).

Symptoms that signal the presence of hallucinations and clearly reflect the behavior of a schizophrenic:

• laughter for no reason;
• detachment when speaking;
• sudden manifestations of anxiety;
• conversations with oneself;
• sudden changes in behavior during conversation.

2. Delusional ideas. Obsessive thoughts and delusions of persecution often manifest themselves in suspicions of close people of evil intentions. Impaired functioning of consciousness may be accompanied by a flurry of complaints in various government agencies demanding that the “culprits” be punished. Or the patient besieges hospital rooms in a desperate search for imaginary diseases. So who is a schizophrenic? All pathological jealous people then fall under the manic nature of delirium... But do not rush - you should look for a fantastic, rather than plausible handwriting, for example:

• the appearance of unmotivated aggression;
• implausible stories;
• constant complaints;
• groundless fear;

3. Aggression. This form of behavior is easily identified because it is associated with harm to a living being. At the same time, aggression is not a reaction to an external stimulus; it is impulsive in nature and provoked by a disorder of thinking. Signs:

• negative attitude towards others;
• insomnia;
• impulsiveness;
• restlessness;
• unfounded suspicion;
• increased arousal.

Such symptoms allow one to suspect a pathology of a schizoid nature.

4. Movement disorders. There are two types of disturbances here: stupor and agitation. The first option is characterized by freezing in an immobilized position. A schizophrenic does not eat and does not react to others, focusing his gaze on one point. Excitement, on the contrary, is accompanied by restlessness and incoherence of speech, which is interrupted by sudden silence.

Famous people

Let us think about whether those “unfortunates” who, being sick, were able to amaze the world with their creativity, can be called mentally retarded. The most famous schizophrenics are direct proof that it is very possible to live with this diagnosis.

Vincent Van Gogh

Always persecuted by society, a beggar and a failure, he did not receive recognition during his lifetime and was unable to build a family. Attacks of delirium, nightmarish hallucinations, masochism, suicidal tendencies, gloom and aggression were the artist’s constant “guests,” but they helped him write dozens of masterpieces. Van Gogh either constantly rushed around the room or froze in an awkward pose for hours. According to one version, in a severe stage of insanity, he cut off part of his own ear, allegedly in a fit of repentance after another quarrel with a friend.

Friedrich Nietzsche

The German philosopher was called obsessed; his hallmark was megalomania and his own superiority.

Nietzsche often slept on the floor, barricaded himself, and behaved like an animal. Wild acts committed in public places include inarticulate screams, hugging a horse, quenching one's thirst with one's own urine from a boot.

Jean-Jacques Rousseau

The eminent philosopher and traveler suffered from paranoia, expressed in persecution mania. He saw conspiracies everywhere, abandoned friends, essentially turning into a wanderer.

Nikolai Vasilievich Gogol

The Russian writer was constantly tormented by attacks of claustrophobia and psychosis. Apathy, hypochondria (fear of death) and a state of lethargy could suddenly give way to excessive activity and excitement. At times Gogol fell into a real “stupor”, not even reacting to physical influences. Knowing about his trait, the writer was very afraid of being buried alive.

Mikhail Afanasyevich Bulgakov

Having become addicted to morphine during the war, our compatriot was quite on the needle. Officially mental disorder the writer was not given any credit: those around him associated all his quirks and attacks with drugs.

Main misconceptions

Assumptions about how schizophrenics behave are often false and far-fetched. Let's try to answer the main stereotypical questions.

	Reality
There is no way to help people with this diagnosis.	Everything is not at all hopeless: with timely treatment, the patient can live freely in society
All schizophrenics are dangerous	Not necessarily: the state of aggression is not inherent in every patient
Schizophrenia is a condition of split personality	Fundamentally wrong, because dual (multiple) personality disorder is a different, less common disease
This disease is very rare	The risk of development for any race is 1% - not so little
The percentage of people suffering from schizophrenia does not depend on gender	Signs of the disease appear more often in men than in the weaker half of humanity

Diagnostics

And yet, how to determine whether a schizophrenic is a person or not? Is it really based on changes in his behavior alone? Of course not, because doctors make the diagnosis after a comprehensive examination, laboratory tests and a detailed medical history.

When identifying schizophrenia, psychiatrists rely on several criteria. In particular, the presence of at least two symptoms from the attached list, repeated in a potential patient for a month, indicates a clear predisposition to the disease:

• confused thinking with incoherent speech;
• delusional ideas;
• hallucinations;
• disorganized or catatonic behavior;
• difficulties in everyday life: difficulties in performing duties at work, at home, at school, in self-care;
• communication problems;
• negative symptoms: apathy, lack of emotion, lack of speech.

Forecast

Having decided on the question of who a schizophrenic is, I want to believe that there is hope with such a depressing diagnosis. Disorders of this kind can develop favorably, but you just need to promptly identify the disease and begin drug treatment. If the symptoms appear in adulthood, then therapy is easier. It is much more difficult to cope with symptoms when diagnosing schizophrenia in early childhood. Medicines, complex treatment and the support of loved ones help the patient to lead a full life independent life, controlling symptoms and suppressing attacks.

Treatment

Experts will tell relatives how to behave with a schizophrenic, because proper organization the patient has free time great importance. Involvement in cultural events, walks, occupational therapy - all this has a beneficial effect on the patient’s condition during the recovery period.

As for drug treatment, it is also quite effective: according to statistics, up to 40% of people with a confirmed diagnosis return to their usual rhythm of life. Outpatient care is provided to patients during remission or minor exacerbations. In other cases, a hospital is indicated.

Often, certain antipsychotics are prescribed for treatment: Aminazine, Stelazine, Sonapax, Frenolone. In cases of depression and low-grade schizophrenia Antidepressants and tranquilizers are used, in particular Phenazepam. To suppress side effects so-called correctors are used ("Parkopan", "Akineton"), which relieve tremors, stiffness, restlessness and muscle twitching. If psychotropic therapy is ineffective, the doctor may prescribe insulin comatose or electroconvulsive treatment methods.

Very typical for this form is the appearance of the patient - red and dry skin, feverish shine in the eyes, dry tongue. Patients are excited, rushing about ( sometimes within the bed), exhibit negativism. Sometimes febrile schizophrenia can occur with confusion. Extremely severe cases occur with the phenomenon of toxicdermia, in which serous, purulent and hemorrhagic blisters form on the skin. The mortality rate for this form is very high and ranges from 10 to 50 percent. The duration of the attack varies from several hours to several weeks.

Schizophrenia in the form of a prolonged pubertal attack
This is a single-episode schizophrenia that develops with characteristic symptoms adolescence syndromes. The course of this form is relatively favorable.

It makes its debut in adolescence, often with the manifestation of heboid syndrome. This syndrome is characterized by a distortion of the emotional and volitional characteristics of the individual. It manifests itself in the perversion of instincts, primarily sexual, and in extreme egocentrism. Highest moral principles ( concepts of good and evil) and emotions ( compassion) are lost, and a tendency to antisocial behavior arises. Lost interest in any activity ( first of all to study), opposition arises to any established norms of behavior or generally accepted views. Behavior becomes rude, inappropriate and unmotivated. It is worth noting that, despite the loss of interest in studying, intellectual abilities remain.

The first stage of this condition begins at 11 - 15 years of age and lasts 2 - 3 years. The second stage begins at 17–18 years of age and is manifested by a detailed clinical picture of this syndrome. The condition of adolescents during this period is completely decompensated, and sophisticated cruelty, aggression and hysterical reactions predominate in behavior.
At the third stage ( 19 - 20 years old) the condition stabilizes and there are no further complications. The condition stabilizes at the level of the previous stage. Patients begin to regress in mental development, and it seems that they are “not growing up.” At the fourth stage, which begins from 20 to 25 years, the condition reverses. Behavioral disorders are smoothed out, negativism and the tendency to antisocial actions are lost. All that remains are periodic mood swings and outbursts of anger.

In addition to heboid syndrome, dysmorphophobic and psychasthenic syndromes can be observed. In the first case, young people are worried about their body weight, the shape of their nose, future baldness, some birthmarks, and so on. This anxiety is accompanied by hysterical reactions and depression. In the second case, obsessions and fears are revealed ( phobias), anxious suspiciousness.

Childhood schizophrenia

Childhood schizophrenia accounts for one fifth of all psychoses on the schizophrenia spectrum. A flow is usually a continuously flowing form. The fur-like and recurrent form of schizophrenia occupies an intermediate state.

The most malignant form is childhood schizophrenia. early age. Its symptoms become most distinct by 3 to 5 years of age. The disease begins with alienation from close relatives and loss of interest in the world around us. Lethargy and apathy are combined with stubbornness and a certain hostility. Neurosis-like states arise - fears, anxiety, mood swings appear. Behavior is characterized by foolishness, mannerism, and echolalia ( repetition of words) and echopraxia ( repetition of actions). Sharp negativism also predominates - the child does everything the opposite. At the same time, ambivalence is observed - joy abruptly gives way to crying, excitement turns into apathy. Children's games take on a primitive character - playing with a thread, a wheel, collecting some objects.

Against the background of these changes, the main symptoms of schizophrenia appear - slowing mental development, emotional impoverishment, autism ( appearance of autism symptoms). At the age of 5 years, a detailed clinical picture appears - hallucinations appear ( visual and olfactory), pronounced affective disorders. Hallucinations are rudimentary ( V initial stage ), and if delirium appears, it is also not systematized and fragmented. Since intellectual abilities regress and it is difficult for the child to express his thoughts, a delusional mood most often develops. It is expressed in suspicion and mistrust, which do not acquire verbal expression. The defect condition develops very quickly. After 2 - 3 years, speech and previously acquired skills regress, behavior becomes primitive. The so-called “oligophrenic ( idiot) component".

The main features of early childhood schizophrenia are rapid development personal and intellectual defect with bright severe symptoms autism.
Schizophrenia, which began in more recent years, is not as malignant. late age- after 5 - 7 years. The oligophrenic component is not so strongly expressed, but, at the same time, adaptation disorders and mental immaturity are observed.

Diagnosis of schizophrenia

Since the origin of schizophrenia is multifaceted and still unknown, to date there are no specific tests or instrumental methods for diagnosing this disease.
The diagnosis is made based on a detailed study of the patient’s medical history, his complaints, as well as data provided by his relatives, friends and social workers.

At the same time, when making a diagnosis, the doctor takes into account standardized diagnostic criteria. These criteria are represented by two main systems - the International Classification of Diseases, 10th revision ( ICD-10), developed by the United Nations, and the Diagnostic Manual of Mental Disorders ( DSM-V), developed by the American Psychiatric Association.

Criteria for diagnosing schizophrenia according to ICD-10

According to this classification, an attack of schizophrenia must last at least six months. Symptoms of schizophrenia must be present constantly - in everyday life, at work. The diagnosis of schizophrenia should not be made against the background severe lesions brain or due to depression.

The ICD distinguishes two groups of criteria - first and second rank.

First-rank criteria for schizophrenia are:

• sound of thoughts ( patients interpret this as an “echo of thoughts”);
• delusions of influence, influence, or other delusional perceptions;
• auditory hallucinations ( vote) of a commentary nature;
• crazy ideas that are ridiculous and pretentious.

According to the ICD, at least one of these symptoms must be present. The symptom must be clearly defined and present for at least a month.

The second rank criteria for schizophrenia are:

• constant but mild hallucinations ( tactile, olfactory and others);
• interruption of thoughts ( especially noticeable during a conversation when a person suddenly stops);
• phenomena of catatonia ( excitement or stupor);
• negative symptoms - apathy, emotional dullness, isolation;
• behavioral disorders - inactivity, self-absorption ( the patient is exclusively occupied with his thoughts and experiences).

There must be at least two of these symptoms at diagnosis, and they must also last for at least a month. In the diagnosis of schizophrenia, clinical observation of the patient is of particular importance. By monitoring a patient in a hospital setting, the doctor becomes more clear about the nature of the patient’s complaints. It is especially important to analyze the patient’s communication with other patients, with staff, and with the doctor. Often patients try to hide perception disorders ( vote), which can only be revealed through detailed observation of the patient.

The patient’s appearance, especially his facial expressions, also acquires great diagnostic significance. The latter is often a mirror of his inner experiences. So, she can express fear ( with commanding voices), grimacing ( for hebephrenic schizophrenia), detachment from the outside world.

Diagnostic criteria for schizophrenia according to DSM-V

According to this classification, symptoms must last for at least 6 months. At the same time, changes in behavior at home, at work, and in society should be observed. Changes may concern self-care - the patient becomes sloppy and ignores hygiene. Neurological pathology must be excluded, mental retardation or manic-depressive psychosis. One of the following criteria must be clearly observed.

The diagnostic criteria for schizophrenia according to DSM-V are:
Characteristic phenomena- must be observed for at least a month, and 2 or more symptoms are required to make a diagnosis.

• rave;
• hallucinations;
• impaired thinking or speech;
• phenomena of catatonia;
• negative symptoms.

Social maladjustment- changes are observed in all areas of the patient’s life.

Stability of symptoms- the symptoms of the disease are very stable and last for six months.

Severe somatic ( bodily), neurological disease. The use of psychoactive substances is also excluded.

No deep affective disorders, including depression.

Diagnostics various forms schizophrenia

Form of schizophrenia	Diagnostic criteria
Paranoid schizophrenia	The presence of delirium is required: persecution; greatness; impact; high origin; special purpose on earth and so on. Presence of votes ( judging or commenting).
Hebephrenic schizophrenia	Motor-volitional disorders: foolishness; emotional inadequacy; baseless euphoria. The following triad of symptoms: inaction of thoughts; euphoria ( unproductive); grimacing.
Catatonic schizophrenia	Phenomena of catatonia: stupor; excitement ( transition from one to another); negativism; stereotypies.
Undifferentiated form	Includes signs of paranoid, hebephrenic and catatonic schizophrenia. The wide variety of symptoms makes it impossible to determine the form of the disease.
Residual schizophrenia	Negative symptoms in emotional sphere (emotional flatness, passivity, decreased communication skills); Having at least one psychotic episode in the past ( exacerbation).
Simple form schizophrenia (not included in the American Classification of Diseases)	onset of the disease at 15–20 years of age; decrease in emotional and volitional qualities; behavior regression; personality change.

It should be noted that this list of symptoms is present in already developed clinical forms schizophrenia. Then making a diagnosis is not difficult. However, on initial stages Symptoms of the disease are erased and appear with varying frequency. Therefore, very often during initial hospitalization, doctors question the diagnosis of schizophrenia.

Diagnostic tests and scales

Sometimes various diagnostic tests are used to “uncover” the patient. In them, the patient’s thinking is revealed most clearly ( provided that the patient cooperates with the doctor), and emotional disorders come out. The patient may also inadvertently talk about his experiences and suspicions.

Tests and scales used in the diagnosis of schizophrenia

Test	Direction	Patient's task
Luscher test	Examines the emotional state of the patient.	The patient is offered cards with 8 colors, which he must choose in order of preference. Each color has its own interpretation.
Test MMPI	Multidisciplinary study of the patient's personality on 9 main scales - hypochondria, depression, hysteria, psychopathy, paranoia, schizophrenia, social introversion.	The test consists of 500 questions, divided into scales, to which the patient answers “yes” or “no”. Based on these answers, a personality profile and its characteristics are formed.
Method of unfinished sentences	The patient's attitude towards himself and others is examined.	The patient is offered sentences with various topics and situations, which he must complete.
Leary test	Exploring your “I” and ideal “I”	The patient is given 128 judgments. Of these, he chooses those that, in his opinion, apply to him.
TAT test	Explores the patient’s inner world, his thoughts and experiences.	Photographs are offered that depict situations with different emotional contexts. The patient must compose a story using these cards. At the same time, the doctor analyzes the patient’s answers and draws up a picture of his interpersonal relationships.
Carpenter scale	Assess the patient's mental status. Contains 12 correlated features ( interconnected) with schizophrenia.	Signs that exclude schizophrenia are marked with a “-” sign, those that include them are marked with a “+” sign.
PANSS scale	Assesses positive and negative symptoms of schizophrenia. Symptoms are divided into scales - positive, negative and general.	The doctor asks questions to the patient regarding his condition, experiences and relationships with others. The severity of symptoms is assessed on a seven-point scale.

Luscher test

What is the Luscher test, what colors are included in it?

The Luscher test refers to indirect methods for studying personality. It allows you to obtain information about personality characteristics through the assessment of certain characteristics and individual components - emotions, level of self-control, character accentuation. The author of this test is Swiss psychologist Max Luscher. He is also the author of The Color of Your Character, What Color is Your Life, and others. Max Luscher first put forward the theory that color is important tool diagnostics After this, he proposed a theory of color diagnostics, which underlies his test.

During testing, a person is offered cards that depict rectangles painted in different colors. Based solely on personal preference for a particular shade, the examinee must select several colors in a certain order.

The basic philosophy of this test is that color preferences ( that is, color choice) are carried out subjectively, while the perception of color occurs objectively. Subjectively translates as “from the point of view of the subject,” in this case the person taking the test. Subjective choice is a choice at the level of the patient’s emotions and feelings at the moment. Objectively - this means regardless of the consciousness and perception of the patient. The difference in perception and preference measures the subjective state of the person being tested.

The test uses four primary and four secondary colors, each of which symbolizes certain emotions. The choice of one color or another characterizes the mood, some stable traits, the presence or absence of anxiety, and so on.

When and how is the Luscher test performed?

The Luscher test is a study that is used in psychology and psychotherapy to identify traits that determine a person’s personality. This analysis also makes it possible to establish the subject’s communication skills, resistance to stress, propensity for a certain type of activity, and other points. If a person is in a state of anxiety, the test will help determine the causes of anxiety.

The Luscher test is often used by employers to assess certain qualities of a potential candidate to fill existing vacancies. Distinctive feature of this study is the short time period required to conduct it.

How is the test performed?

To conduct this test, special color tables are used, which are called stimulus material. Psychodiagnostician ( testing person) provides the person being examined with the opportunity to choose certain colors in a certain sequence, and then, based on the choice, makes a conclusion about the person’s mental state, his skills and personality traits.

Stimulus material for the color test

There are 2 types of color charts that can be used to perform the Luscher test. A complete study is carried out on the basis of 73 shades of color, which are divided into 7 color tables. This analysis is used in cases where other personality diagnostic methods are not used. Second option color test carried out using one table, which includes 8 colors. The data obtained as a result of a full study is not much different from the information that can be obtained using a short test. Therefore, in most cases in modern psychology, a short color test based on one table is used. The first 4 color shades from this table are primary colors, the remaining 4 are secondary colors. Each color symbolizes a person's state, feeling or desire.

The following values ​​of primary colors are distinguished when performing the Luscher test:

• blue (feeling of contentment and calm);
• green-blue (perseverance, perseverance);
• red-orange (agitation, tendency to aggression, strong will);
• yellow (active social position, tendency to violent expression of feelings);
• grey (neutrality, apathy);
• brown (absence vitality, need for rest);
• violet (need for self-expression, conflict of opposites);
• black (protest, completion, anxiety).

The above values ​​are general and are provided for informational purposes only. The specific meaning of color when compiling a characteristic is determined by how the respondent indicated this color, and what colors are in the neighborhood.

Color test scheme

The test should be carried out in daylight, avoiding direct sunlight on the color cards. Before starting the study, the psychodiagnostician explains to the interviewee the principle of the test. When choosing a color, the patient should rely only on his preferences at the time of the analysis. That is, when asked by a psychologist to choose a color card, the respondent should not choose a color that suits him or matches, for example, the shade of his clothing. The patient must indicate the color that appeals to him the most among the other colors presented, without explaining the reason for his choice.

After the explanation, the psychodiagnostician places the cards on the table, mixes them and turns them over with the color surface facing up. Then asks the patient to choose one color and put the card aside. Then the cards are shuffled again, and the subject must again choose the color that he likes best among the remaining 7 cards. The procedure is repeated until the cards run out. That is, upon completion of this stage, the patient should have 8 color cards, among which the first one chosen by him should be liked the most, the last one the least. The psychologist writes down the colors and sequence in which the cards were pulled out.
After 2 - 3 minutes, the psychodiagnostician mixes all 8 cards and again asks the patient to choose the most attractive color. At the same time, the psychologist should explain that the purpose of the test is not to test memory, so you should not remember in what sequence the cards were selected at the first stage of the test. The subject must choose colors as if he were seeing them for the first time.

All data, namely the colors and the sequence in which they were selected, are entered into a table by the psychodiagnostician. The cards selected at the first stage of the test make it possible to determine the state to which the person being examined strives. The colors indicated in the second stage reflect the real state of affairs.

What are the results of the Luscher test?

As a result of testing, the patient distributes colors into eight positions:

• first and second- clear preference ( is written with the signs “+ +» );
• third and fourth- just a preference ( is written with the signs "x x");
• fifth and sixth- indifference ( is written with the signs "= =» );
• seventh and eighth- antipathy ( is written with the signs "- -» ).

At the same time, colors are also coded with corresponding numbers.

There is the following color numbering according to the Luscher test:

• blue - 1;
• green - 2;
• red - 3;
• yellow - 4;
• purple - 5;
• brown - 6;
• black - 7;
• gray - 0.

Psychologist ( psychodiagnostician, psychotherapist), the person conducting the test numbers the colors according to the corresponding positions and then proceeds to interpret the results.

For clarity, you can consider the following approximate diagram of test results:

+	+	-	-	x	x	=	=
2	4	3	1	5	6	7	0
Explanations: in this case, the test taker chose yellow and green as a clear preference, red and blue are just preferences, he is indifferent to purple and black, but he has antipathy to gray and black.

Interpreting the results takes into account not only the choice of preferred color and what it means, but also the combination of colors chosen.

Interpretation of Luscher test results

Main color	Position	Interpretation
Blue	+	It says that the patient strives for peace everywhere and in everything. At the same time, he actively avoids conflicts. The combination with the color purple indicates a low level of anxiety, and with brown- about increased anxiety.
	-	Interpreted as severe tension and a state close to stress. Combination with black color - oppression, a feeling of a hopeless situation.
	=	Indicates superficial and shallow relationships.
	x	Indicates the person being tested is ready for satisfaction.
Green	+	Indicates the patient's positive attitude and desire for active activity. The combination with brown speaks in favor of a feeling of dissatisfaction.
	-	It is an indicator of a depressed and even somewhat depressed state. The combination with the color purple indicates a depressed state, and with the gray color it indicates increased irritability and anger.
	=	Speaks of a neutral attitude towards society ( society) and lack of pretensions.
	x	Rated as a high level of self-control.
Red	+	It indicates that the patient is actively striving for activity, to overcome problems, and is generally optimistic. The combination with the color purple indicates the desire to be the center of attention and make an impression.
	-	Indicates a state close to depression, stress, searching for a way out of the current situation. The combination in gray is regarded as nervous exhaustion, powerlessness, sometimes aggression pent up inside.
	=	Assessed as a lack of desires and increased nervousness.
	x	It indicates that the patient being tested may be experiencing stagnation in his life, which is causing him some annoyance.
Yellow	+	Indicates a positive attitude and the need for self-affirmation. The combination with gray indicates a desire to escape from the problem.
	-	Interpreted as a feeling of anxiety, resentment and disappointment. The combination with black indicates alertness and tension.
	=	It speaks of an increased critical attitude towards society.
	x	Indicates readiness for a relationship.

Violet	+	The need for sensual self-expression. It also indicates that the person is in a state of intrigue. The combination with red or blue is interpreted as a love experience.
	-	It says that a person is rational and not prone to fantasizing.
	=	Indicates that a person is in a state of stress due to his own rash actions.
	x	It indicates that the person being tested is very impatient, but at the same time strives for self-control.
Brown	+	Indicates that the person is tense and possibly afraid. The combination of brown and red colors indicates that a person is striving for emotional release.
	-	Interpreted as a lack of life perception.
	=	It says that the person being tested needs rest and comfort.
	x	Interpreted as an inability to have fun.
Black	+	Indicates the negative emotional background of the person being tested and the fact that he is trying to get away from problems. Combination with green indicates agitation and an aggressive attitude towards others.
	-	Interpreted as a desire to receive support from others.
	=	Indicates that the person is in search and that he is close to frustration ( to a state of frustrated plans).
	x	It speaks of denial of one's fate and that the person being tested wants to hide his true feelings.
Grey	+	Indicates that a person protects himself from the outside world and that he does not want to be known. The combination of gray and green indicates that the person being tested is experiencing hostility and wants to separate from society ( society).
	-	It is interpreted as a desire to bring everything closer and subordinate to oneself.
	=	Indicates a person’s desire to get out of an unfortunate situation.
	x	It indicates that the person being tested is trying to resist negative emotions.

Is it possible to make a diagnosis based on the results of the Luscher test?

It should be immediately noted that based on this test it is impossible to make a definitive diagnosis. The Luscher test, like other projective tests, is used in conjunction with other methods of diagnosing mental states - observation, questioning and additional scales. An analogue of projective tests in psychiatry is a phonendoscope in therapy. So, in order to listen to the lungs, the therapist resorts to using a phonendoscope. Hearing wheezing in the lungs can tentatively suggest a diagnosis of bronchitis or pneumonia. So it is in psychodiagnostics. The test is just a way to analyze some personality characteristics. The test results provide a more complete picture of the patient’s emotional state, and sometimes of his inclinations. This is then added to the information already obtained by the doctor to obtain the most complete clinical picture.

Let's say the test reveals a depressed and anxious emotional background of the patient. This is added to previously identified anamnestic data, for example, to a recent divorce. Additionally, the doctor may conduct a test to assess depression using the Hamilton scale. In addition to all this, observation data from the patient can come to the rescue - his avoidant behavior, reluctance to communicate, loss of interest in the world around him. All this can result in a diagnosis such as depression.

Thus the Luscher test is auxiliary method diagnosis of affective ( emotional) disorders, but no more. He can also determine the most stable personality traits of the patient, the level of anxiety and contradictions. Availability high level anxiety may indicate anxiety disorder, post-traumatic disorder.

Like other tests, the Luscher test is focused on qualitative ( but not quantitative) assessment. For example, it may indicate the presence of depressed mood, but it does not indicate how severe the depression is. Therefore, to obtain an objective result, the Luscher test is supplemented with other quantitative tests and scales. For example, a scale for assessing depression and anxiety. Only after this can the doctor make a presumptive diagnosis.

These tests are not mandatory and do not lead to a diagnosis of schizophrenia. However, they help identify emotional, affective and other disorders. They are also used in assessing the effectiveness of treatment ( PANSS scale).

Treatment of schizophrenia

How can you help a person in this condition?

Help for people with schizophrenia should be provided by families, social workers, employees day hospitals and, of course, the attending physician. The main goal is to establish stable and long-term remission. Everything is also done to ensure that negative symptoms of the disease appear as late as possible.

To do this, it is necessary to monitor periods of exacerbation and stop them correctly ( that is, “to treat”). For this purpose, hospitalization in appropriate institutions is recommended when the first symptoms of exacerbation appear. Timely hospitalization will avoid protracted psychosis and prevent its complications. Comprehensive inpatient treatment is the key to long-term remission. At the same time, a long hospital stay leads to a lack of social stimulation and isolation of the patient.

Psychosocial therapy and support
After eliminating the acute psychotic state, the stage of social therapy and support begins, the main role in which is played by the patient’s relatives.
This stage is very important in the rehabilitation of patients, as it helps prevent the premature development of the defect. It may include the most various types psychotherapy ( art therapy, occupational therapy, cognitive training), various projects and movements.

Cognitive training is aimed at teaching the patient new information processing skills. The patient learns to adequately interpret the events that happen to him. Cognitive therapy models can focus both on the formation of judgments and the content of those judgments. During these trainings, work is done on the patient's attention and thinking. The patient talks about his feelings and interpretations, while the therapist traces these symptoms and determines where the distortion occurred. For example, the patient hears himself being asked to hand over some object ( book, ticket), while he himself is thinking about it. This gives rise to the false belief that people can read his thoughts. Ultimately, a delusional idea of ​​persecution is formed.

Family therapy is no less important in the socialization of patients. It is aimed at training both the patient’s relatives and the patient himself, as well as developing new skills in them. The method examines interpersonal connections and family relationships.

IN Western countries An alternative approach to treating schizophrenia is soteria. This approach uses lay personnel and low doses of antipsychotic medication. To implement it, special “soteria houses” are created where patients are treated. Movements to destigmatize ( "remove label") mental patients are periodically conducted by such organizations as Paranoia Network, Hearing Voices Network.

Psychological adaptation allows patients with schizophrenia to realize themselves - to graduate from an educational institution, to start working. Since the debut of schizophrenia occurs at a crucial age for a career ( 18 - 30 years old), then special programs are being developed for career guidance and training for such patients.

Self-help groups for patients and their relatives are becoming increasingly common. The acquaintances made in these groups contribute to the further socialization of patients.

Drug treatment

Medicines that are used to treat schizophrenia are called antipsychotics or antipsychotics. This group of drugs is represented by a wide range of medications with a diverse chemical structure and spectrum of action.
Neuroleptics are usually divided into old ( typical) and new ( atypical). This classification is based on the principle of action on certain receptors.

Typical ( classic, old) antipsychotics
Typical antipsychotics preferentially bind to and block D2-dopamine receptors. The result of this is a pronounced antipsychotic effect and a reduction in positive symptoms. Representatives of typical neuroleptics are aminazine, haloperidol, tizercin. However, these drugs have varying side effects. Causes neuroleptic malignant syndrome and movement disorders. They have cardiotoxicity, which significantly limits their use in the elderly. However, they remain the drugs of choice for acute psychotic conditions.

Atypical ( new) antipsychotics
These drugs act to a lesser extent on dopamine receptors, but more on serotonin, adrenaline and others. As a rule, they have a multireceptor profile, that is, they act on several receptors simultaneously. As a result, they have far fewer side effects associated with dopamine blockade, but less pronounced antipsychotic effect ( This opinion is not shared by all experts). They also have an anti-anxiety effect, improve cognitive abilities, and exhibit an antidepressant effect. However, a group of these medications causes severe metabolic disorders, such as obesity, diabetes mellitus. Atypical antipsychotics include clozapine, olanzapine, aripiprazole, and amisulpride.

An entirely new class of antipsychotic drugs is the group of partial agonists ( aripiprazole, ziprasidone). These drugs act as partial blockers of dopamine and as its activators. Their action depends on the level of endogenous dopamine - if it is increased, the drug blocks it, if it is decreased, it activates it.

Antipsychotic drugs used in the treatment of schizophrenia

Preparation	Mechanism of action	How is it prescribed?
Haloperidol	Blocks dopamine receptors. Eliminates delusions, hallucinations, obsessions. Causes side effects such as movement disorders ( tremor), constipation, dry mouth, arrhythmia, low blood pressure.	When relieving a psychotic state ( exacerbation) is prescribed intramuscularly at 5-10 mg. The initial dose is 5 mg three times a day. After stopping the attack, they switch to the tablet form. The average therapeutic dose is from 20 to 40 mg per day. Maximum - 100 mg.
Aminazine	Blocks central receptors of adrenaline and dopamine. Has a strong sedative ( soothing) action. Reduces reactivity and motor activity (eliminates excitement). It has a negative effect on the heart and its blood vessels, greatly lowering blood pressure.	For severe agitation and aggression, the drug is prescribed intramuscularly. The maximum single dose is 150 mg, daily dose is 600 mg. After eliminating the excitement, they switch to tablet form - from 25 to 600 mg per day, the dose is divided into three doses. The maximum dose for oral administration is 300 mg. For febrile schizophrenia, the drug is administered intravenously. Single dose- 100 mg, maximum - 250 mg.
Thioridazine	Blocks dopamine and adrenaline receptors in the brain. Depresses all psychomotor functions. Particularly effective for relieving agitation, tension and anxiety.	In stationary conditions ( in the hospital) the daily dose can vary from 250 mg to 800 per day; in outpatients ( Houses) - from 150 to 400 mg. The dose is divided into 2 - 4 doses. Take the drug orally after meals.
Levomepromazine	Blocks dopamine receptors in various structures brain Eliminates delusions, hallucinations, agitation.	The period of the acute phase is stopped by intramuscular administration of 25 to 75 mg. Gradually switch to tablets, 50 - 100 mg per day.
Olanzapine	Mainly affects serotonin receptors, to a lesser extent - dopamine receptors. Has a moderate antipsychotic effect, smoothes negative symptoms. Side effects include obesity.	Taken orally, once. The initial dose of 5 - 10 mg is gradually increased ( within 5 - 7 days) up to 20 mg.
Clozapine	It has dopamine-blocking and adrenolytic properties. Reduces aggression and impulsive behavior, dulls emotions, suppresses excitement. At the same time, it causes such a life-threatening complication as agranulocytosis ( decrease in the number of granulocytes in the blood).	The drug is taken orally. Single dose - 50 mg, daily - from 150 to 300. The dose is divided into 2 - 3 doses. The maximum daily dose is 600 mg. Treatment is carried out under periodic monitoring of blood tests.
Amisulpride	Reduces positive symptoms. The antipsychotic effect is realized together with the sedative. At a dose of 50 mg per day it has an antidepressant effect.	IN acute period schizophrenia dose ranges from 400 to 800 mg. The dose is divided into two doses. If negative symptoms dominate in the clinic, the dose varies from 50 to 300 mg.
Aripiprazole	It has a blocking-activating effect on dopamine receptors. In addition to reducing positive symptoms, it eliminates negative symptoms - improves cognitive functions, memory, and abstract thinking.	The initial dose of the drug is 10 mg per day. The drug is used once, regardless of food intake. The maintenance dose is 15 mg.
Ziprasidone	Acts on dopamine, serotonin, norepinephrine receptors. It has antipsychotic, sedative and anti-anxiety effects.	Taken orally during meals. The average therapeutic dose is 40 mg ( divided into two doses).

The main goal of drug treatment is to prevent new relapses and defects. It is very important that taking medications is not limited to the walls of the hospital. After eliminating the acute psychotic state, the doctor selects the optimal maintenance dose that the patient will take at home.

How to respond to strange behavior of patients?
Do not forget that the sensations experienced by the patient ( hallucinations), are absolutely real for him. Therefore, attempts to dissuade him that his visions are erroneous will not bring any benefit. At the same time, recognizing his delusional ideas and becoming a participant in the “game” is not recommended. It is important to point out to the patient that everyone has their own opinion on this matter, but their opinion is also respected. You can't make fun of patients or over their statements) or try to deceive them. It is necessary to establish a kind and reassuring relationship with the patient.

Prevention of schizophrenia

What should you do to avoid schizophrenia?

The prevention of schizophrenia, like most mental illnesses, is the main task in psychiatric practice. The lack of complete and accurate knowledge about the origin of this disease does not allow us to develop clear preventive measures.

Primary prevention of schizophrenia is represented by medical and genetic consultations. Patients with schizophrenia and their spouses should be warned about the increased risk of developing a mental disorder in their offspring.
Secondary and tertiary prevention consists of early diagnosis of this disease. Early detection of schizophrenia allows you to effectively treat the first psychotic episode and establish long-term remission.

What can trigger the onset of schizophrenia?

According to some theories of the occurrence of schizophrenia, there is a certain predisposition to this disease. It consists in the presence of structural abnormalities in brain tissue and certain personality traits. Under the influence of stress factors, decompensation of these features and structures occurs, resulting in the development of disease.

Factors contributing to the exacerbation of schizophrenia are:

• Withdrawal of medications- is one of the most common reasons, according to which decompensation of remission occurs.
• Somatic pathology- also provokes exacerbations. Most often this is cardiovascular, respiratory pathology or kidney disease.
• Infections- often accompanied by the development of excitement.
• Stress- also leads to decompensation of the patient’s condition. Conflicts in the family, among friends, and at work are inducers of psychotic states.