Schizophrenia is a mental disorder characterized by a distorted perception of the surrounding reality, uncontrolled actions, emotional instability and inadequate attitude towards other people.

A schizophrenic is not aware of the reality of what is happening around him. The thoughts that arise in his imagination and all those events that happen in reality are mixed up in his head.

The information that has made its way into the consciousness of such a person is a chaotic set of colored pictures, all kinds of sounds and meaningless images. It often happens that a schizophrenic completely denies the existing reality - he lives life in your illusory world. Anyone who is doomed to suffer from this disorder has serious problems in all areas of life, starting from school and in subsequent adult life. Due to mental pathology, a person withdraws into himself and experiences difficulties in communication.

It is impossible to get rid of schizophrenia forever. Throughout his life, the patient is forced to take special medications in order to somehow alleviate the symptoms of the disease.

Causes of schizophrenia

Genetic factor

There is a close connection between schizophrenia and genetics. If there were cases of schizophrenia among first-degree relatives in the family, then automatically there is a risk of developing a deviation from other family members.

External reasons

Experimental data and observations show that the occurrence of schizophrenia is indirectly related to chronic stress. Elevated levels of the hormone cortisol provoke the development of schizophrenia.

A group of stress conditions is noted caused by external factors, which, in turn, can play a role in the formation of schizophrenia:

Abnormalities of brain structures

Abnormal brain biochemistry, combined with disrupted anatomy, is fraught with the development of various forms of schizophrenia. Thus, a significant percentage of patients with schizophrenia are diagnosed with enlargement of the ventricles of the brain, which indicates a deficiency of tissue in the remaining parts of the brain. Data available about dysfunction of the frontal lobe of the brain, designed for planning decisions and logical thinking. There is evidence that abnormal development of the temporal lobes is also associated with the occurrence of schizophrenia.

Forms of schizophrenia

Depending on the signs of the disease, distinguish schizophrenia:

• continuously flowing
• paroxysmal
• sluggish
• mixed

Continuously ongoing schizophrenia by its name makes it clear that it does not have remission. This type of illness leads to rapid personality disintegration.

The second type of disease manifests itself only as a single attack, after which comes long-term remission. Subsequent attacks are more severe.

The clinical picture of sluggish schizophrenia does not lead the patient to psychosis, and even without drug treatment, its symptoms may disappear for a short period of time.

Swiss psychiatrist Eugen Bleuler revealed a complex of four signs of schizophrenia:

Symptoms of schizophrenia

Schizophrenia does not develop spontaneously. At first, some symptoms make themselves felt, after which new ones join them, and the existing ones noticeably intensify.

Early symptoms of schizophrenia The following deviations include:

• Violation of the speech apparatus. The patient cannot give a detailed answer to the question posed. All his answers are monosyllabic and not logically constructed. There are long pauses between phrases.
• Agedonia. The schizophrenic no longer receives moral satisfaction from the activities that previously fascinated him. For example, before his illness, a person was fond of clay modeling, but when faced with schizophrenia, he lost all interest in this activity.
• Weak expression of emotions, up to their complete absence. The person does not concentrate on the eyes of the interlocutor; complete indifference is visible on his face.
• Inability to perform any tasks. A schizophrenic simply does not see any point in this. For example, a patient does not wash his hands because he does not consider it necessary, because they will be dirty again.

The full range of symptoms of schizophrenia divided into several large groups:

Positive symptoms

These include delusions and hallucinations. The main themes of the delusional idea are persecution, influence, relationships. Delirium of influence is expressed by the fact that the patient experiences fear of invisible rays, currents, and waves. It seems to him that they are using them to control his mind.

Each time the schizophrenic manages to come up with new arguments, but they are less and less convincing. The content of a delusional idea is largely related to the social status of the individual, his subculture and the era in which he lives. For delirium of persecution characterized by abstruseness and uncertainty. The schizophrenic claims that he is the target of a mysterious clan or terrorist group, but he cannot answer who exactly is looking for him.

As a rule, schizophrenia is accompanied by auditory verbal hallucinations. A person hears voices giving him orders or commenting on what is happening.

Negative symptoms

Another name for these symptoms is deficiency symptoms. We talk about them when there is a disappearance or significant reduction of previous functions. In other words, if a person had a set of certain qualities before the onset of the illness, but after the illness he lost them, or they became less pronounced.

Main negative symptoms:

• lack of will
• apathy
• passivity
• weak expression of emotions
• lethargy and lethargy
• speech and thinking disorder
• lack of initiative
• detachment
• inability to carry on a conversation
• poor concentration
• rapid exhaustion of the nervous system
• sudden mood swings
• lack of self-control
• inability to find a way out of the current situation
• problems with switching attention from one activity to another

Often due to lost motivation, schizophrenics don't want to leave the apartment and meet other people. They stop taking care of their appearance and do not follow the rules of hygiene, as a result of which they push passersby away from them.

For the speech of a person suffering from schizophrenia, The following signs are characteristic:

Disorganized symptoms

These include incoherent speech and chaotic thinking and behavior.

Affective symptoms

This includes depression, suicidal tendencies, self-flagellation.

Treatment and prevention of schizophrenia

Any mental disorder requires comprehensive treatment. In addition to the medications prescribed to the patient, he is also recommended to undergo a course of psychotherapy and psychoanalysis. The patient's hormonal levels should be checked. In some cases, doctors use laser irradiation of blood. Phototherapy and electroconvulsive therapy have proven themselves to be the best.

As is known, schizophrenia is an incurable disease. But family and friends are quite capable of stopping the patient’s symptoms and providing him with a normal life. It is important to create the necessary conditions for the prevention of schizophrenia: thoroughly ventilate the living space, regularly walk in the fresh air, eat right and engage in physical therapy. Of course, it is necessary to isolate the patient from negative emotions and experiences. This should apply not only to everyday events, but also to literature, films, and musical compositions.

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

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

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

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

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

Schizophrenia - symptoms and signs

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

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

Signs of schizophrenia

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

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

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

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

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

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

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

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

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

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

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

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

Positive symptoms of schizophrenia

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

Positive symptoms of schizophrenia include the following:

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

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

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

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

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

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

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

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

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

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

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

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

Negative symptoms of schizophrenia

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Disorganized symptoms

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

Affective symptoms

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

Typical syndromes characteristic of schizophrenia

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

So, Typical positive syndromes of schizophrenia include the following:

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

Typical negative syndromes of schizophrenia are the following:

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

Symptoms of schizophrenia in men, women, children and adolescents

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

The first symptoms of schizophrenia (initial, early)

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

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

Symptoms of different types of schizophrenia

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

Paranoid (paranoid) schizophrenia

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

Catatonic schizophrenia

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

Hebephrenic schizophrenia

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

Simple (mild) schizophrenia

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

Undifferentiated schizophrenia

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

Residual schizophrenia

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

Postschizophrenic depression

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

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

Manic schizophrenia (manic-depressive psychosis)

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

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

Acute schizophrenia (attacks of schizophrenia) - symptoms

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

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

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

Continuous schizophrenia

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

Sluggish (latent) schizophrenia

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

Sluggish schizophrenia has the following stages:

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

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

Neurosis-like schizophrenia

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

Alcoholic schizophrenia - symptoms

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

Alcoholic psychosis can occur in three ways:

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

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

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

Causes and symptoms of schizophrenia - video

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

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

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

But few people understand who a schizophrenic is and how he differs from a 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, is sometimes accompanied by painful symptoms associated with physical suffering, and can make him dangerous for 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 of such patients is "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 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 that have power over him, will punish him if he becomes an individual. 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 at the moment and what we have felt before, at key moments in our lives; 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 terrified 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 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 talented, creative people there really are many 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, a 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 Liman 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 a permanent intimate relationship 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 are characterized by obsessive states: recurring dreams or visions, strange, periodically 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 eye, 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 to provoke as many cases of schizophrenia as possible.

He himself is in front of unusual, mentally unhealthy people. symptom of schizoidity. Therefore, it is better not to try to diagnose 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 best doctor cannot go against his wishes. 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 of 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 mental state 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.

Knowing the symptoms of the disease is very useful, especially when it comes to such a serious mental illness as schizophrenia. People have always had many questions regarding the symptoms of this disease. How does the disease begin? Are there any specific symptoms of schizophrenia in men, or are they the same as in women? Are there differences between the symptoms of different types of schizophrenia?

What is it?

Schizophrenia is a progressive chronic mental illness. Usually it manifests itself with a wide variety of symptoms - from mild symptoms to severe syndromes leading to disability.

The most striking symptoms: psychopathic and neurosis-like syndromes, visual and auditory hallucinations, delusions, hebephrenic and catatonic symptoms, affect disorders. The chronic course of the disease leads to a specific personality defect: a schizophrenic’s mental processes are disrupted, the perception of the surrounding world is distorted, and individual personality traits are erased.

Although schizophrenia is a distinct disorder, it includes a range of disorders with similar symptoms and signs. Since this disease can manifest itself in a wide variety of disorders, schizophrenics may notice different signs of this disease and its dynamics, which require different treatment methods. In addition, the diagnosis of this disease is based only on the symptoms of schizophrenia, since laboratory diagnostic methods are currently not available.

Pathogenesis and etiology

No one knows for sure the causes of schizophrenia. Until now, only the necessary conditions for the occurrence of this disease have been established, and the most common symptoms and signs have been identified.

The occurrence of the disease can be explained as follows: a person initially has a readiness for illness, which is determined by various factors. Such factors cause vulnerability, which includes defense mechanisms. Such mechanisms contribute to the isolation and isolation of a person and provoke symptoms of schizophrenia, such as autism, self-limitation of personality and disturbances of the self. If at the same time external factors begin to influence men or women, schizophrenia develops.

Clinical picture

The huge variety of manifestations of this disease forces psychiatrists to identify more and more new types of schizophrenia. Each type has its own symptoms, signs and course of the disease.

The most famous is the classification of this disease, based on the identification of the predominant symptoms. According to this classification, schizophrenia is: catatonic, hebephrenic (early childhood or adolescence), residual (residual), hallucinatory-paranoid and simple. Sometimes, in addition to the main forms of schizophrenia, hypochondriacal, progressive, circular, latent (hidden), neurosis-like and psychopathic-like, senile (late, occurs in older people) and alcoholic forms of schizophrenia are added.

However, significant variability in schizophrenia symptoms was then discovered. Therefore, the classification of schizophrenia according to the principle of “leading symptoms and signs” is no longer relevant. The modern classification of schizophrenia takes into account not only the prevailing symptoms, but also the type and degree of development of the disease.

According to this classification, there are 3 forms of schizophrenia: continuous, periodic, paroxysmal-progressive (coat-like - from the German “exacerbation”, “attack”).

This classification covers all the symptoms of schizophrenia and allows us to trace the dynamic development of the disease.

The initial (first) stage of schizophrenia begins with prodromal symptoms. The first signs are not very noticeable, then more severe symptoms appear, which can be acute or gradual. The onset of schizophrenia may be preceded by stressful events or circumstances.

Classic schizophrenia consists of several alternating phases of exacerbations and pronounced remissions. Even the first attacks experienced change the patient’s condition. After each attack, the condition worsens more and more, and post-psychotic depression may begin. Symptoms progress for about 5 years, and then in most cases the process stops. Positive symptoms decrease over time, while negative symptoms gradually increase. The patient stops engaging in purposeful activities, becomes passive, and periodically requires hospitalization. Without proper care, schizophrenics can become marginalized.

When talking about the symptoms of schizophrenia, there are several key points to note:

1. There are no specific symptoms or signs of schizophrenia;
2. Symptoms may change over time.
3. Symptoms are influenced by characteristics such as education, intelligence, and cultural characteristics of the patient.

Premorbid

Premorbid schizophrenia refers to prepsychotic personality characteristics before the onset of the disease. Usually the future patient is schizoid or schizotypal. Such a child or teenager has few friends, and in adulthood this develops into isolation, incl. and in women. Such a child is obedient and usually harmless. Teenagers, both boys and girls, do not go on dates, do not like sports, and prefer to listen to music or watch TV. The first signs of schizophrenia are sometimes noticeable in childhood or adolescence. The manifestation of the first signs in older people is less common. Senile schizophrenia is also rare.

Childhood schizophrenia, like adolescent schizophrenia, takes a long time to develop. The child periodically complains of headaches, muscle or back pain, upset or weak digestion. In adults, the level of any activity decreases: professional, personal and social. The person becomes anxious or absent-minded, interested in philosophy, some abstract ideas, religious or occult problems. Whims and strange behavior appear, emotions are impoverished, perceptions change, bizarre speech and especially eccentric ideas appear.

General symptoms: the patient is too talkative, sometimes takes pretentious poses. Sometimes behavior can be aggressive to the point of violence due to hallucinations. Patients exhibit egocentrism and autism, have speech impairments, and behavior is not goal-directed. Sometimes signs such as strange movements, various tics, and mannerisms are observed. Often schizophrenics do not comply with norms of social behavior.

Catatonic agitation: a state of great chaotic activity.

Catatonic stupor (catatonia): the patient looks lifeless; he exhibits the following symptoms: negativism, dumbness or thoughtless submission. A typical sign of catatonic stupor is waxy flexibility.

Affects: a common symptom of affect disorder is the impoverishment of emotions, but sometimes, on the contrary, there are intense inappropriate emotions. Schizophrenics themselves complain of isolation, fear, confusion, and ambivalence of feelings.

Perception: Hallucinations occur in any sensory modality. Auditory hallucinations (voices in the head) are very common. Visual hallucinations are also observed. Olfactory, gustatory or tactile hallucinations are rare. Schizophrenics also often experience sensations of damage to the body.

Thinking: The main symptom of thought disorder is delusion. It can be different: delusions of persecution, grandeur, somatic or religious. A schizophrenic may be insanely passionate about symbolic, psychological or philosophical ideas. He also expresses strange somatic complaints that have no convincing basis.

Another symptom is “loss of boundaries of the Self.” A person has no understanding of where his body begins and ends. Other signs and symptoms: inadequate associations, destruction or impoverishment of the content of speech, racing thoughts, impaired attention, memory loss, lack of logic, excessive thoroughness of thinking.

Impulsivity: In the acute stage of this disease, schizophrenics often harm themselves or others, and neglect normal norms of behavior. Impulsive actions are usually committed under the influence of hallucinations.

Orientation: schizophrenics are usually well oriented in their personality, place, time. But sometimes they give strange, florid answers to questions, especially girls.

Memory: usually without impairment.

Criticality: a schizophrenic is rarely aware of his illness.

Truthfulness: you should always check the information received from the patient.

Possible risk factors

Factor	Risk of developing schizophrenia
Schizophrenia in relatives (in general)	70 %
Schizophrenia in monozygotic twin	50%
Both parents are schizophrenic	40-60%
Schizophrenia of a dizygotic twin or 1st degree relative	18%
Schizophrenia in a 2nd degree relative	6%
Schizophrenia in a 3rd degree relative	3%
Accommodation in the city	3%
Migration	3%
Diseases of pregnant women in the first two trimesters	3%
Birth in spring or winter	1,1%
Obstetric and prenatal complications	3%
Use of drugs or psychostimulants	3%
Father's age is more than 35 years	3%
Male gender	1.4%

The gender factor does not have a significant impact on the development of schizophrenia: the prevalence of this disease among men and women is the same. However, in general, in women the course of the disease is more favorable.

The first difference between schizophrenia in women and schizophrenia in men is that the attack-like form occurs much more often in women. In men, the continuous form of the disease is more common. The second difference is that the peak of the disease in men is 20-28 years old, in women it is 26-32 years old. Symptoms of schizophrenia are usually more pronounced in men than in women.

Treatment of the disease

Treatment of schizophrenia is always a multifaceted treatment. Psychopharmacotherapy, psychotherapy and sociotherapy complement each other perfectly. Most of the time, schizophrenics can be treated on an outpatient basis. Outpatient treatment of this disease, for both women and men, is good in that the patient retains his few social connections. However, many complicating situations can only be eliminated in a hospital.

The main treatment is carried out with broad-spectrum neuroleptics. Their dosage depends on the type of medicine and the severity of symptoms, as well as individual differences. Treatment with antipsychotics is aimed at the target symptoms.

In acute catatonic states, high doses of antipsychotics are indicated. In severe forms of schizophrenia, infusions of electrolyte solutions and ECT are used. Depressive disorders in schizophrenia are treated with a combination of antidepressants and antipsychotics, wakefulness therapy (long-term sleep deprivation) has been successfully used, and ECT is also possible.

Schizophrenia is the most mysterious and little-studied pathology. A complex, severe mental disorder destroys the human essence, negatively affecting the ability to think, speak, and perceive reality. The name “schizophrenia” was first used by the 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 mental and mental functions), but the 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, and 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 of large cities are more at risk of encountering the disease. 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 brings with it deep social problems, up to and including complete maladaptation 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, visual hallucinations, and delusional ideas characteristic of the patient.

The brain requires a lot of energy to fuel the focus of excitation. As a result, the body deprives other brain areas of essential nutrients. 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. 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 of 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 of relapse of the 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 previously present (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 of a simple type with gradual personality regression and the absence of acute psychosis.
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 predict the development of pathology.

Treatment of the disease

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

Medication. The basis of pharmacological treatment is the use of antipsychotropic medications. 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 cases, schizophrenia develops into a 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, it is impossible to talk about complete recovery. The patient's condition can only be significantly improved and the person returned to normal life.