Very typical for this form is the appearance of the patient - red and dry skin, feverish gleam in the eyes, dry tongue. Patients are excited, rushing about ( sometimes within the bed) are negative. Sometimes febrile schizophrenia can occur with clouding of consciousness. Extremely severe cases occur with the phenomenon of toxidermia, in which serous, purulent and hemorrhagic blisters form on the skin. Mortality in this form is very high, ranging 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-attack schizophrenia that develops with syndromes characteristic of adolescence. The course of this form is relatively favorable.

It makes its debut in adolescence, often with manifestations 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 desires, primarily sexual, and in extreme egocentrism. Highest moral principles ( concepts of good and evil) and emotions ( compassion) are lost, there is a tendency to anti-social actions. Loss of interest in any activity first of all to study), there is opposition to any established norms of behavior, generally accepted views. Behavior becomes rude, inadequate and unmotivated. It is worth noting that, despite the loss of interest in learning, intellectual abilities remain.

The first stage of this state begins at the age of 11-15 and lasts 2-3 years. The second stage begins at the age of 17 - 18 and is manifested by a detailed clinical picture of this syndrome. The state of adolescents at this period is completely decompensated, and sophisticated cruelty, aggression and hysterical reactions predominate in their behavior.
At the third stage ( 19 - 20 years old) there is a stabilization of the condition and the absence of further complications. The state stabilizes at the level of the previous stage. Patients begin to regress in mental development, and it seems that they "do not grow up." At the fourth stage, which begins at the age of 20 - 25, the reverse development of the state occurs. Behavioral disorders are smoothed out, negativism and a tendency to antisocial actions are lost. Only periodic mood swings and outbursts of anger remain.

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

Childhood schizophrenia

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

The most malignant form is schizophrenia in childhood. Its symptoms become most pronounced by the age of 3-5 years. The disease begins with alienation from close relatives and loss of interest in the outside world. 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, echolalia ( repetition of words) and echopraxia ( repetition of actions). Sharp negativism also prevails - the child does the opposite. At the same time, ambivalence is observed - joy is abruptly replaced by crying, excitement turns into apathy. Children's games acquire a primitive character - playing with a thread, a wheel, picking up some objects.

Against the background of these changes, the main symptoms of schizophrenia appear - mental retardation, emotional impoverishment, autism ( onset of autism symptoms). At the age of 5 years, a detailed clinical picture appears - hallucinations appear ( visual and olfactory), pronounced affective disturbances. Hallucinations are rudimentary ( in the early stages), and if delirium appears, then it is also not systematized and fragmented. Since the intellectual abilities regress, and it is difficult for the child to express his thoughts, a delusional mood is most often formed. It is expressed in suspicion and distrust, which do not acquire verbal formalization. The defect 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 is the rapid development of a personality and intellectual defect with pronounced symptoms of autism.
Not so malignant is schizophrenia, which began at a later age - after 5-7 years. The oligophrenic component is not so pronounced, but at the same time, adaptation disorders and mental immaturity are observed.

Diagnosis of schizophrenia

Since the origin of schizophrenia is multifaceted and is still not exactly known, there are currently no specific tests or instrumental methods for diagnosing this disease.
The diagnosis is made on the basis of 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, in making a diagnosis, the doctor takes into account standardized diagnostic criteria. These criteria are represented by two main systems - the International Classification of Diseases of the 10th revision ( ICD-10), developed by the United Nations, and the Handbook for the Diagnosis 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 should last at least six months. Symptoms of schizophrenia must be present constantly - at home, at work. The diagnosis of schizophrenia should not be made in the setting of severe brain damage or depression.

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

The criteria for the first rank in schizophrenia are:

• the sound of thoughts patients interpret this as an "echo of thought");
• delusions of influence, influence or other delusional perceptions;
• auditory hallucinations ( vote) commenting character;
• 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 expressed and present for at least a month.

The criteria for the second rank in schizophrenia are:

• persistent but mild hallucinations ( tactile, olfactory and others);
• interruption of thoughts especially noticeable when talking, 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 the patient in a hospital, the nature of the patient's complaints becomes more clear to the doctor. It is especially important to analyze the communication of the patient with other patients, with staff, with the doctor. Often, patients try to hide perceptual disturbances ( vote), which can only be detected by detailed observation of the patient.

The appearance of the patient, 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 ( with hebephrenic schizophrenia), detachment from the outside world.

DSM-V Diagnosis Criteria for Schizophrenia

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

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

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

Social maladaptation- there are changes in all spheres of the patient's life.

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

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

There are no deep affective disorders, including depression.

Diagnosis of various forms of schizophrenia

It should be noted that this list of symptoms is present in already developed clinical forms of schizophrenia. Then the diagnosis is not difficult. However, at the initial stages of the disease, the symptoms are erased and appear at different intervals. Therefore, very often during the initial hospitalization, doctors question the diagnosis of schizophrenia.

Diagnostic tests and scales

Sometimes, various diagnostic tests are used to "uncover" a patient. In them, the patient's thinking opens up most clearly ( provided that the patient cooperates with the doctor), and emotional disorders come out. Also, the patient may inadvertently talk about his experiences and suspicions.

Tests and scales used in the diagnosis of schizophrenia

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 get information about personality traits through the assessment of certain characteristics and individual components - emotions, the level of self-control, character accentuation. The author of this test is the Swiss psychologist Max Luscher. He is also the author of the books The Color of Your Character, What Color Is Your Life, and others. Max Luscher first put forward the theory that color is an important diagnostic tool. After that, he proposed the theory of color diagnostics, which underlies his test.

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

The underlying philosophy behind this test is that color preferences ( i.e. color choice) are carried out subjectively, while the perception of color occurs objectively. Subjectively translated as "from the point of view of the subject", in this case the person who is taking the test. Subjective choice is a choice at the level of emotions and feelings of the patient at the moment. Objectively - this means regardless of the consciousness and perception of the patient. The difference in perception and preference makes it possible to measure the subjective state of the tested person.

The test uses four primary and four secondary colors, each of which symbolizes certain emotions. The choice of a particular color characterizes the mood, some stable features, 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 in order to identify the traits that determine a person's personality. Also, this analysis allows you to establish the communication skills of the subject, resistance to stress, a tendency to a certain type of activity and other points. If a person is in a state of anxiety, the test will help to identify the causes of anxiety.

The Luscher test is often used by employers in order to evaluate certain qualities of a potential candidate to fill existing vacancies. A distinctive feature of this study is the short time period required for its implementation.

How is the test carried out?

To conduct this test, special color tables are used, which are called stimulus material. Psychodiagnostic ( person doing the test) 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 mental state of the person, his skills and personality traits.

Stimulus material for color test

There are 2 types of color charts that can be used to perform the Luscher test. A complete study is conducted on the basis of 73 shades of color, which are divided into 7 color tables. Such an analysis is used in cases where other methods of personality diagnostics are not used. The second version of the color test is carried out using one table, which includes 8 colors. The data obtained from 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 state, feeling or desire of a person.

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

• blue (feeling of contentment and calmness);
• green-blue (perseverance, perseverance);
• red-orange (agitation, tendency to aggression, strong will);
• yellow (active social position, a tendency to violent manifestation of feelings);
• grey (neutrality, apathy);
• brown (lack of vitality, need for rest);
• Violet (need for self-expression, conflict of opposites);
• black (protest, end, alarm).

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

Scheme of the color test

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

After the explanation, the psychodiagnostic puts the cards on the table, mixes them up and turns them upside down. Then asks the patient to choose one color and put the card aside. Then the cards are shuffled again, and the subject must re-select the color that he likes the most among the remaining 7 cards. The process is repeated until the cards run out. That is, at the end of this stage, the patient should have 8 color cards, among which the first, chosen by him, should be his favorite, the last the least. The psychologist writes down the colors and the sequence in which the cards were pulled out.
After 2 - 3 minutes, the psychodiagnostic 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 order the cards were selected at the first stage of the test. The subject must choose colors as if seeing them for the first time.

All data, namely the colors and the sequence with which they were selected, are entered by the psychodiagnostic into a table. The cards selected at the first stage of the test allow you to determine the state to which the person being examined is striving. 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 in eight positions:

• first and second- explicit preference ( written with signs "+ +» );
• third and fourth- just a preference written with characters "xx");
• fifth and sixth- indifference ( written with characters "= =» );
• seventh and eighth- antipathy ( written with characters "- -» ).

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

There is the following numbering of colors according to the Luscher test:

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

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

For clarity, we can consider the following approximate scheme of test results:

When interpreting the results, not only the choice of the preferred color and what it means is taken into account, but also the combination of the selected colors.

Interpretation of the results of the Luscher test

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

It should be immediately noted that on the basis of this test it is impossible to make a definite diagnosis. The Luscher test, like other projective tests, is used in combination with other methods for diagnosing mental conditions - 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 uses a phonendoscope. Hearing wheezing in the lungs, he may tentatively assume a diagnosis of bronchitis or pneumonia. So it is in psychodiagnostics. The test is just a way of analyzing some personality characteristics. The results of the test allow you to give a more complete picture of the patient's emotional state, sometimes about his inclinations. Further, this is summarized to the information already obtained by the doctor to obtain the most complete clinical picture.

Suppose the test revealed a depressed and anxious emotional background of the patient. This adds up to previously identified anamnestic data, such as a recent divorce. Additionally, the doctor may conduct a test to assess depression using the Hamilton scale. In addition to all this, observational data on the patient can come to the rescue - his avoidant behavior, unwillingness to communicate, loss of interest in the world around him. All this can result in such a diagnosis as depression.

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

Like other tests, the Luscher test is focused on qualitative ( but not quantitative) evaluation. For example, it may indicate the presence of a depressive mood, but 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 that, the doctor can put forward a presumptive diagnosis.

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

Treatment of schizophrenia

How can you help a person in this condition?

Assistance to patients with schizophrenia should be provided by families, social workers, day hospital workers and, of course, the attending physician. The main goal is to establish a stable and long-term remission. Everything is also done to ensure that the 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 ( i.e. "treat"). For this, hospitalization in appropriate institutions is recommended when the first symptoms of exacerbation appear. Timely hospitalization will avoid prolonged psychosis and prevent its complications. Full inpatient treatment is the key to long-term remission. At the same time, a long stay in the hospital leads to a lack of social stimulation and isolation of the patient.

Psychosocial Therapy and Support
After the elimination of the acute psychotic state, the stage of social therapy and support begins, in which the patient's relatives play the main role.
This stage is very important in the rehabilitation of patients, as it helps to prevent the premature development of the defect. It may include a variety of types of 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 happening to him. Models of cognitive therapy can be focused both on the formation of judgments and on the content of these judgments. During these trainings, work is carried out on the patient's attention and his thinking. The patient talks about his feelings and interpretations, and the therapist at the time traces these symptoms and determines where the distortion occurred. For example, the patient hears being asked to pass some object ( book, ticket) while he himself thinks about it. This gives rise to the false notion that people can read his mind. Ultimately, a delusional idea of ​​persecution is formed.

Family therapy is equally important in the socialization of patients. It is aimed at training both the patient's relatives and the patient himself, as well as at developing new skills in them. The method considers interpersonal connections and relationships in the family.

In Western countries, soteria is an alternative approach to treating schizophrenia. This approach uses unprofessional staff and low doses of antipsychotics. For its implementation, special “houses-soterias” are created, where patients are treated. Movements in favor of destigmatize ( "remove label") mental patients are periodically conducted by organizations such 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 onset of schizophrenia falls on a career-determining age ( 18 - 30 years old), then special programs for vocational guidance and training of such patients are being developed.

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

Medical treatment

Medicines that are used in the treatment of schizophrenia are called antipsychotics or antipsychotics. This group of drugs is represented by a wide range of drugs with a variety of chemical structures and spectrum of action.
Antipsychotics 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 neuroleptics preferentially bind to D2-dopamine receptors and block them. The result of this is a pronounced antipsychotic effect and a reduction in positive symptoms. Representatives of typical antipsychotics are chlorpromazine, haloperidol, tizercin. However, these drugs have different side effects. Cause neuroleptic malignant syndrome, 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 on dopamine receptors to a lesser extent, but to a greater extent on serotonin, adrenaline and others. As a rule, they have a multireceptor profile, that is, they act simultaneously on several receptors. As a result, they have much fewer side effects associated with dopamine blockade, but a 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 medicines causes pronounced metabolic disorders, such as obesity, diabetes mellitus. Atypical antipsychotics include clozapine, olanzapine, aripiprazole, amisulpride.

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

Antipsychotic drugs used in the treatment of schizophrenia

The main objective of drug treatment is the prevention of new relapses and defects. It is very important that the intake of medicines is not limited to the walls of the hospital. After the acute psychotic state has been eliminated, the doctor selects the optimal maintenance dose that the patient will take at home.

How to respond to the strange behavior of patients?
Do not forget that the sensations experienced by the patient ( hallucinations) are absolutely real to him. Therefore, attempts to dissuade him that his visions are erroneous will not be useful. At the same time, it is not recommended to recognize his crazy ideas and become a participant in the “game”. It is important to indicate to the patient that everyone has their own opinion on this matter, but their opinion is also respected. You can't joke about patients or over their statements) or try to deceive them. It is necessary to establish a kind and favorable relationship with the patient.

Prevention of schizophrenia

What should be done to avoid schizophrenia?

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

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

What can trigger 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 anomalies in the tissues of the brain and certain personality traits. Under the influence of stress factors, decompensation of these features and structures occurs, as a result of which the disease develops.

Factors contributing to the exacerbation of schizophrenia are:

• Drug withdrawal- is one of the most common reasons why remission decompensation occurs.
• Somatic pathology- also provokes exacerbations. Most often it is a cardiovascular, respiratory pathology or kidney disease.
• infections- often accompanied by the development of arousal.
• Stress- also leads to decompensation of the patient's condition. Conflicts in the family, among friends, at work are inducers of psychotic states.

Schizophrenia is a polymorphic mental disorder characterized by the breakdown of affects, processes of thought and perception. Previously, specialized literature indicated that about 1% of the population suffers from schizophrenia, but recent large-scale studies have shown a lower figure - 0.4-0.6% of the population. Symptoms and signs of schizophrenia can begin to appear at any age, but most often the disease occurs after 15 and before 25 years of age. Interestingly, for unknown reasons, the female part of the population is more prone to mental disorder than men.

Let's find out: what is schizophrenia and how does it manifest itself in a person, and what is the cause and can this mental disorder be treated?

What is schizophrenia?

Schizophrenia is a mental illness characterized by distortions of thought (delusions) and perceptions (hallucinations). The term "schizophrenia" literally means "split mind", which does not quite correctly reflect the essence of this disease, because many people confuse it with a dissociative personality disorder (popularly - a split personality disorder).

The schizophrenic is not aware of the reality of what is happening around. Thoughts that arise in his imagination, and all those events that occur in reality, are mixed in his head.

The information that has made its way into the consciousness of such a person is a chaotic set of color pictures, all kinds of sounds and meaningless images. It often happens that a schizophrenic completely denies the existing reality - he lives life in his illusory world.

Schizophrenia is often combined with depression, anxiety disorders, drug addiction and alcoholism. Significantly increases the risk of suicide. It is the third most common cause of disability after dementia and tetraplegia. It often entails pronounced social maladaptation, resulting in unemployment, poverty and homelessness.

Men and women suffer from schizophrenia equally often, but the city dwellers more often, the poor more often (more stress). If the patient is male, the disease has an earlier onset and a more severe course, and vice versa.

Causes

Causes of occurrence:

• genetic predisposition;
• prenatal factors (for example, the development of abnormalities as a result of problems with abnormal intrauterine development of the fetus);
• social factors (the background of urbanization contributes to the growth of mental disorders);
• experiences in early childhood can cause schizophrenia;
• environmental factors;
• brain injury during childbirth or immediately after them;
• social isolation;
• alcoholism causes schizophrenia and a person, and contributes to a gene mutation, due to which the disease can develop in his children;
• drug addiction leads to the development of schizophrenia and gene mutation, similar to alcohol.

They note a group of stressful conditions caused by external factors, which, in turn, can play a role in the formation of schizophrenia:

• Viral infection that affected the brain during childbirth
• Fetal hypoxia
• Birth of a child before the end of the full term of pregnancy
• Exposure to the virus in infancy
• Loss of parents or separation from family
• Physical and mental injury as a result of domestic violence

The first signs of schizophrenia

Like any other disease, schizophrenia has the first signs that you should definitely pay attention to and consult a psychiatrist.

Signs of schizophrenia:

1. Inability to perform habitual actions, as the patient does not see the obvious meaning in them. For example, he does not wash his hair, as the hair will get dirty again;
2. Speech disorders, which are expressed mainly in monosyllabic answers to the questions posed. If the patient is nevertheless forced to give a detailed answer, he will speak slowly;
3. Low emotional component. The patient's face is inexpressive, it is impossible to understand his thoughts, he avoids meeting his eyes with the interlocutor;
4. Low concentration on any subject or object of action;
5. Anhedonia is also an early sign of the disease. At the same time, even activities that previously attracted a person, gave him moments of joy, now become completely uninteresting.
6. Affective inadequacy - is expressed in a completely inadequate reaction to various events and actions. For example, when a person sees a drowning person, he laughs, and when he receives some kind of good news, he cries, etc.

It is worth thinking about the disease in the following cases:

• drastic changes in character
• the appearance of neurotic symptoms - persistent fatigue, increased anxiety, constant
• reviewing decisions and actions,
• nightmares,
• vague sensations in the body.

A person prone to the development of schizophrenia loses interest in life, family, notes a depressive state, suddenly becomes addicted to alcohol, draws gloomy pictures.

It is worth noting that such symptoms to one degree or another can manifest themselves in each person, therefore, it is necessary to diagnose the signs of schizophrenia. qualified specialist.

Classification

Based on clinical symptoms, the DSM-4 distinguishes five types of schizophrenia:

• Paranoid schizophrenia is characterized by undisturbed thought processes, the patient mainly suffers from delusions and hallucinations. It is paranoid delusions that predominate, delusions of grandeur, persecution or influence prevail. Emotional disorders are not very pronounced, sometimes absent altogether.
• Disorganized schizophrenia (hebephrenic) - disorders of thinking and emotional flattening are revealed.
• Catatonic schizophrenia - psychomotor disorders predominate.
• Undifferentiated schizophrenia - psychotic symptoms are detected that do not fit into the picture of catatonic, hebephrenic or paranoid schizophrenia
• Sluggish, neurosis-like schizophrenia: age of onset is 16 to 25 years on average. There is no clear boundary between the initial and manifest periods. Neurosis-like phenomena dominate. Schizophrenic psychopathization is observed, but the patient can work, maintain family and communication ties. At the same time, it is clear that the person is “distorted” by the disease.

Symptoms of schizophrenia in adults

Patients with schizophrenia have a combination of disorders in thinking, perception, as well as emotional and volitional disorders. The duration of symptoms is observed for about a month, but a more reliable diagnosis can be established within 6 months of observation of the patient. Often at the first stage, a transient psychotic disorder is diagnosed with signs of a schizophrenia-like disorder, as well as symptoms of schizophrenia.

Positive symptoms

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 in the sense of "good", but only reflects the fact that something new has appeared. That is, there was a certain increase in the qualities inherent in man. Positive symptoms of schizophrenia include:

• Rave;
• hallucinations;
• Illusions;
• A state of arousal;
• Inappropriate behaviour.

Negative symptoms and signs of schizophrenia

• Lethargy - the patient loses the ability to quickly respond and make decisions, is not able to maintain a conversation.
• Emotional coldness - the line is erased in the mimic and voice manifestation of feelings. The monotony of speech and "frozen" facial expressions are characteristic.
• Asociality - it becomes difficult for a person to stay in society. He does not make contact well and makes acquaintances.
• Low concentration of attention, which leads to the inability to lead a normal life, go to work, do things you love. Even the handwriting is distorted.
• Loss of interest in what is happening. In contrast, obsessive ideas appear, on which a person gets hung up. A productive life becomes unreal.

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

With the course of the disease, the symptoms of emotional manifestations of schizophrenia weaken to the point of emotional dullness.

• Emotional decline affects the entire appearance of the patient, facial expressions and behavior.
• His voice becomes monotonous, inexpressive.
• The face loses its expressiveness and becomes motionless (sometimes a mask-like face, monotony of voice, angular movements, their stiffness are a manifestation of the side effects of drugs, this should be taken into account).

How schizophrenia manifests itself: hallucinations, delusions and aggression

Before determining schizophrenia in a person, it is recommended to observe him. In patients with this pathology, a distorted picture of the environment appears, created by their own consciousness on the basis of the initial correct signals.

The onset of the disease (manifest period) is characterized by:

1. Delusions of persecution, relationships, meanings, high origin, endowed with a special purpose and ridiculous delusions of jealousy, as well as delusions of influence.
2. Auditory true, as well as pseudo-hallucinations of the commenter, contradictory condemning.
3. Sexual, olfactory, gustatory, and somatic hallucinations.

hallucinations

Hallucinations are disorders of perception and the occurrence of phenomena (objects, sensations) where they do not exist. They can be visual, auditory, tactile and so on. Schizophrenia is characterized by auditory hallucinations of various contents. Auditory hallucinations, or "voices", occur in a person inside the head or from some objects.

There are four types of hallucinatory disorders:

1. auditory - most characteristic of schizophrenia. A voice appears in the head of the patient or from the surrounding objects, which comments, criticizes the actions of a person, or instructs him how to live correctly and what to do;
2. tactile - develop less often auditory. It may seem to the patient that boiling water or, conversely, ice water is being poured onto his skin. Also, patients may complain about the feeling that someone lives inside them (fish swim through the veins, a snake crawls in the stomach);
3. olfactory - the most inexpressive hallucinations. A person complains about the presence of odors that no one but him feels;
4. visual - extremely rarely appear in schizophrenia.

Auditory and visual hallucinations in schizophrenia are manifested as follows:

• conversations with oneself, reminiscent of a conversation or replies to someone's questions (of course, except for remarks like “Where did I put the keys?”);
• laughing for no apparent reason;
• the impression that a person sees and hears what no one else perceives;
• sudden silence, as if he were listening to something;
• preoccupied or anxious look;
• inability to focus on a topic of conversation or a specific task.

Rave

Delusions are cumulative beliefs, conclusions and conclusions that differ from reality. Before acute schizophrenia appears, the patient is delusional and suffers from hallucinations.

There are several tips for recognizing delusional schizophrenia. This is indicated by the following main signs:

• changes in behavior, the appearance of unmotivated aggression;
• constant stories of an implausible nature, like vivid colored dreams;
• groundless fear for one's life and health;
• manifestation of fear in the form of voluntary confinement at home, fear of people;
• constant annoying complaints in the courts for no reason.

As the disease progresses, the patient becomes conflicted and explosive. During the course of the disease, the doctor pays special attention to reasoning - empty reasoning of a permanent nature. In this case, there is no final goal of reasoning. With anhedonia, the ability to enjoy something is lost.

Exacerbation of schizophrenia

A relapse or exacerbation of schizophrenia is the development of an acute phase in which the disorder takes an active course, productive symptoms appear, an adequate assessment of one's condition decreases or is completely lost. Such a condition of the patient can lead to adverse consequences, both for the carrier of the disease and for those around him. In this regard, early recognition of signs of an exacerbation of the disease is of particular importance.

Factors contributing to the exacerbation of schizophrenia are:

• Drug withdrawal is one of the most common reasons why remission decompensates.
• Somatic pathology also provokes exacerbations. Most often it is a cardiovascular, respiratory pathology or kidney disease.
• Infections - often accompanied by the development of arousal.
• Stress - also leads to decompensation of the patient's condition. Conflicts in the family, among friends, at work are inducers of psychotic states.

When the first signs of psychosis appear, you should consult your doctor. The relatives of the carrier of the disorder and the patient himself are already familiar with the manifestations of the disease, so even minor changes should alert them, especially in spring and autumn.

Treatment Methods

The treatment of schizophrenia is carried out primarily with the aim of reducing severe symptoms, reducing the chances of relapses of the disease, as well as the return of symptoms after improvement.

Among the methods used to treat schizophrenia, we highlight the following:

• drug therapy;
• electroconvulsive therapy (used when drug therapy is ineffective, involves the passage of electrical impulses through the brain);
• social therapy (implies the improvement of the patient's living conditions, the long-term implementation of such measures ensures appropriate effectiveness);
• psychotherapy (used as a supportive method of treatment, for example, in combination with drug therapy, helps to alleviate the general condition of the patient).

During the period of remission, maintenance therapy is mandatory; without this, a worsening of the condition is inevitable. As a rule, patients after discharge feel much better, consider that they are cured completely, stop taking drugs, and the vicious circle starts again.

This disease is not completely curable, but with adequate therapy it is possible to achieve a stable remission against the backdrop of supportive treatment.

According to experts, people who suffer from schizophrenia in some cases pose a danger, primarily to themselves. Therefore, cases of suicide among such patients are often recorded. It is also possible the manifestation of violent behavior in those patients who use alcohol or drugs. Therefore, intermittent treatment of schizophrenia is mandatory.

Psychiatrists consider this disorder to be endogenous; external causes that could negatively affect the psyche are not considered. Schizophrenia is classified as a mental disorder that affects the emotional and volitional background of a person, making socialization either difficult or impossible. This pathological deviation is not a feature of character, as was commonly believed several centuries ago.

This is a classic mental illness. It is observed and treated only by specialists. It is impossible to get rid or recover from schizophrenia on your own. Even a temporary cessation of symptoms does not mean a cure. The disease is characterized by long periods of remission, which require the patient to be under the supervision of a treating psychiatrist.

Pathogenesis

The causes of schizophrenia are not fully understood, doctors find it difficult to explain the nature of its occurrence. Somatic manifestations in childhood differ in many ways from manifestations in adults. Therefore, psychiatrists are cautious about making a diagnosis before puberty. There are certain theories that can partly explain why the disease occurs.

One of these theories is genetic predisposition. According to scientists and doctors, various manifestations of the disease can be inherited by close relatives. If the disease is present in one of the parents, there is a 10% chance that the child may develop the same problem in the future. Among twins or twins, a genetic predisposition to the disease is noted in half of the cases. This theory is also proved by the fact that mentally healthy parents have a very low probability that a child can get this mental disorder.

Dysfunctions in the production of dopamine lead to the disease. It is a hormone and neurotransmitter that has a direct impact on the emotional background of a person. If some anomalies in the brain are noted, then this substance is produced in excessive quantities, which can lead to systematic intense mental overexcitation. The result of this condition is hallucinations, paranoia, psychosis, or possession.

The pathological effect of viral agents is another explanation for why schizophrenia occurs. Certain pathological pathogens are isolated, they have the ability to destroy the fibers of nerve cells. The most well-known pathological agent is the herpes virus. With normal immunity, it does not manifest itself in any way, a person is only its carrier. But if any malfunctions occur in the body, the herpes virus can lead to disturbances in the functioning of the brain. The biological causes of schizophrenia explain the occurrence of the disease by the influence of endogenous factors.

Influence of toxoplasmosis

Scientists have suggested that the provoking factor in the onset of the disease is infection with toxoplasmosis or its development and progression in the body. This microorganism develops and multiplies in the cells of small rodents that cats prey on. Eating a sick rodent, the cat itself becomes infected with Toxoplasma, becomes a carrier of this microorganism. When emptying the intestines, Toxoplasma is excreted along with waste products. If the human immune system is in a normal state, Toxoplasma is not a danger to him. When meeting with this microorganism, the human immunity begins to produce antibodies against it, so the person does not experience any symptoms. Toxoplasmosis brings danger only to women during the period of bearing a child, especially if they become infected with the virus for the first time. In such a situation, Toxoplasma causes malformations in the development of the unborn child.

According to statistics, more than 30% of the world's population are carriers of Toxoplasma. Why schizophrenia occurs, the reasons may be hidden in the effect of this simplest microorganism on the human brain. After brain cells are damaged, active production of dopamine begins in it, which entails outbreaks of aggression, the onset of obsession, paranoia and other manifestations.
The negative effects of Toxoplasma are most often exposed to people in old age and children.

From the foregoing, we can conclude that toxoplasmosis itself is not a direct cause of schizophrenia. But in the presence of factors predisposing to the disease, it is an impetus for a more rapid and intensive development of a mental disorder.

Common Causes

It is possible to detect a disease in a person by observing his behavior and actions. The patient has hallucinations, a delusional state, conversations with himself. Often there is apathy, depression, isolation in oneself. Scientists believe that the causes of schizophrenia can be:

1. Heredity.
2. Improper intrauterine development.
3. Emotional turmoil that a person experienced as a child.
4. Brain injury during childbirth.
5. Alcohol abuse, as a result of which the disease can develop both in the alcoholic himself and in his offspring.
6. Addiction.
7. A provoking factor can be a strong emotional overstrain, being in constant stress.

These phenomena are a risk factor for the development of the disease. They are able to provoke the development of the disease.

Psychological roots

According to Swiss scientists, some family attitudes can become a trigger for the onset of the disease. For example, when raising a child, they tell him one thing, but show him another. The child, due to his age, is not able to objectively analyze the dual attitude, he is left alone with all the contradictions to which he cannot find answers on his own. Such contradictions at a certain age can provoke the development of internal psychological problems, and later disorders.

The critical age is puberty. At this time, doctors do not undertake to make a definite diagnosis, even in the presence of schizoid inclinations.

Risk Factors in Children

The psyche of a child is very vulnerable. At an early age, the baby lays the foundations of the psychological perception of reality. In young children and adolescents, the disease often goes undiagnosed. This is due to the nuances of development. Sometimes the presence of some schizoid abnormalities is noted, but the final diagnosis can only be made in adulthood. With the progression of the deviation, mental retardation occurs, and general development is inhibited. The child becomes socially unadapted.

At preschool age, in a child with a tendency to the disease, such deviations in behavior are noted:

• unreasonable fear;
• hallucinations are often observed;
• bouts of prolonged crying;
• strange behaviors;
• there is increased nervous and emotional excitability;
• obsessive state;
• excessive impulsiveness.

Such negative manifestations are accompanied by degradation of the personality.

Serious deviations in the psyche begin to occur during puberty. Symptoms of schizophrenia in a teenager are no different from the manifestations of the disease in adults:

• dissatisfaction with appearance;
• delirium;
• thoughts of suicide or attempts to commit it;
• violations in motor activity;
• the appearance of delusional thoughts and ideas;
• manifestations of aggression, often unreasonable.

It is impossible to determine the presence of pathology at an early age, since some of its signs can be psychosomatic manifestations during the period of personality formation, during a period of protest or a personal crisis.

Specialists, before making a diagnosis, observe the child to confirm that these manifestations are the beginning of schizophrenia, and not character traits.

Hypotheses

Among the main hypotheses for the development of the disease are:

1. Autoimmune. It is described as an aggressive influence of the body on its own brain structures. According to this hypothesis, the production of antibodies to its cells occurs in the body, as a result of which the brain tissue systematically changes.
2. Autointoxication. In the analyzes of some patients with schizophrenia, protein compounds were found that act on the body as toxins. The introduction of these elements into nerve fibers provokes dysfunction in the activity of the brain.
3. Neurobiological. Here, failures in the interaction of nervous structures and their susceptibility to body tissues are considered. With an increase in dopamine, there is a violation in the transmission of serotonin and other neurons.
4. Existential. Its basis is a change in the inner world of a person, which is characterized by a lack of communication with other people. Internal beliefs and ideas are the only correct ones, they are different from the real idea of ​​the world around.

In the last few decades, the attention of scientists and physicians has been attracted by the work of different groups of neurotransmitters and disturbances in their functioning. Neurotransmitters are biologically active structures, their main task is to transport an impulse from one brain neuron to another, to all cells of organs and systems. The main features of neurotransmitters are:

1. Acetylcholine. Its task is to stimulate the activity of the parasympathetic nervous system, it can slow down breathing and heart rate, affects memory, takes an active part in intuition and imagination. Violations in his work are prerequisites for the development of malfunctions in the functioning of the brain.
2. Gamma-aminobutyric acid provokes inhibition of the nervous system, improves blood circulation and metabolism in the brain, takes part in memorization and learning.
3. Adrenaline has an exciting effect, takes part in stress, provokes the appearance of fear, anxiety and other manifestations of danger, regulates blood pressure.
4. Norepinephrine has a stimulating effect, lowers blood pressure.
5. Dopamine is a regulator of motivation, satisfaction and attention.
6. Serotonin controls the biorhythms of sleep, mood, constricts blood vessels, regulates body temperature, respiration, and stimulates the occurrence of an allergic reaction.

The listed neurotransmitters have their own functions and features. Violations in the work of one of them causes a malfunction in those parts of the brain that are responsible for attention, learning, anxiety and other emotional manifestations. As a result of this dysfunction, irreversible changes occur in the cerebral cortex that can cause mental disorders.

Schizophrenia is a complex mental disorder in which a person's mental process is disturbed. This is accompanied by obsessions, hallucinations, persecution mania and the like. The very name of the disease means division of the mind. Schizophrenia has several personality classes. One of them is split personality. People with schizophrenia hear, see, and feel things that other people don't. They can see hallucinations and hear voices, while thinking that this is really true.

The disease is very common and spread throughout the world. With the improvement of the general condition, patients with schizophrenia can work and live a full life. In difficult cases, all care for the patient falls on the family and relatives. Developed medicine does not cure the disease to the end, but helps to ease the symptoms.

Schizophrenia - common symptoms

Schizophrenia is defined by certain symptoms.

Positive symptoms are behaviors that are unique to people with schizophrenia. At the same time, the patient cannot determine where the fantasies are and where the reality is. The manifestation of positive symptoms depends on the availability of treatment. These symptoms include:

• Hallucinations are a condition in which a person sees and hears things that others do not. In some cases, they manifest as voices in the head. They force the patient to certain actions;
• delusion - a false sensation in which there is no reason or root of behavior. In this case, the patient proves his case, even if it is not so. The patient can imagine all sorts of crazy ideas. For example, a sense of greatness, persecution, torture by other people;
• thinking disorder is a condition in which the patient cannot collect his thoughts together. Also, the patient may experience a stoppage of speech during a conversation, when he forgets what he wanted to say;
• movement disorder is the inability to control one's arms, legs, face, or speech. Patients appear awkward and involuntary movements or repetition of the same thing. Immunity and immobility may also be observed.

Negative signs or symptoms represent a reduction in normal capacity and behavior. These symptoms include:

• immobility or facial expression and low voice;
• inability to enjoy life;
• decreased ability to perform and plan certain tasks;
• languid speech. With negative manifestations, patients do not pay attention to personal hygiene and need the help of another person. Mostly negative symptoms occur with severe exacerbations of the disease.

Cognitive signs almost do not appear and are not determined in everyday life. Such symptoms can only be detected with professional diagnostics. These symptoms include:

• weakness of mental abilities (inability to work out the accumulated information and make decisions);
• impaired concentration;
• decreased ability to remember all information. With cognitive symptoms, the patient experiences emotional distress.

Causes of schizophrenia

The causes of schizophrenia are many and there are no main ones. The causes of the disease are ambiguous. They can be divided into 3 categories.

Biological causes and factors. These include:

• viral diseases that a person himself has had, even from an early age. Herpes virus and Epstein-Bar, rubella can be a factor that contributes to the development of mental illness;
• genetic factors from parents to children and between identical twins;
• causes related to immunity and antibodies;
• poisoning with biochemical substances causes the manifestation of the initial stage of schizophrenia.

psychological reasons. These include:

• closed state;
• self-absorption;
• tendency to incomprehensible conversations and speech;
• complex relationships with the outside world;
• difficulty in forming thoughts;
• constant stress and;
• passive state;
• stubbornness, suspiciousness;
• vulnerability, loss of a loved one, feeling of grief.

Social causes include:

• geographic location and urbanization (large cities and rural areas);
• family circumstances (psychological pressure from parents and elders on children);

Constant stress for a long period, emotional and frequent experiences, hormonal changes in adolescents that affect stress resistance and other mechanisms lead to mental attacks.

Diagnosis of a mental disorder

Diagnosis of the disease is carried out in several stages. Primary data are formed after the first visit to the clinic. At the first stage, the causes and features of the development of the disease are identified. Data is also collected on the basis of a survey from relatives and complaints from the patient himself. It is also important to identify symptoms during diagnosis. In addition, schizophrenia can be hereditary. A genetic test is performed to determine heredity. At the next stages, specialized methods are carried out.

For example, biophysiological diagnostics reveals damage to the brain and blood vessels that affect the behavior of the patient. These diagnostics include:

• electroencephalography determines the violation of brain activity. The technique registers brain biorhythms;
• the method of calling potentials registers the reaction of the brain to the incoming information and the external negative environment. Here the visual, auditory, sensory reaction is determined;
• magnetic resonance imaging or MRI for short, determines whether the patient has neoplasms in the head;
• doppler ultrasound examines the general condition of the vessels in the brain and cervical vertebrae.

An examination for schizophrenia reveals vascular disorders that disrupt blood circulation. Doctors also conduct laboratory diagnostic methods. This includes various analyses. They determine inflammatory processes, hormonal changes, drug poisoning and the presence of heavy metals.

All for now.
Sincerely, Vyacheslav.

The causes of schizophrenia are not fully understood. However, there are many hypotheses in this regard. The most recognized of these is the theory of the complex nature of the etiology of schizophrenia. The genetic factor plays a significant role in the development of this disease. People with schizophrenia are most often found in families in which there is a hereditary predisposition to a mental disorder. However, children with schizophrenia can grow up in completely healthy families, and there are many such cases.

Also, the assumption of a violation in the brain processes of the chemical balance, as well as probable anatomical pathologies of the brain, has the right to exist. In addition, some scientists admit that negative environmental conditions, such as stressful situations, could serve as a trigger for the onset of schizophrenia. Many psychiatrists and psychologists believe that only a predisposition to this disease can be inherited, and social pressure can provoke the appearance of a disorder.

Most researchers of this mental disorder agree that schizophrenia cannot be caused by the weakness of the patient's character or mistakes in education. However, children who grow up in a family where one parent suffers from this disease acquire similar symptoms over time.

These acquire various inadequate reactions to an unfavorable external environment. This may be crying, screaming, or any other inadequate reaction. It can also be difficult to talk to him. If the parents did not show the necessary attention to and raised him in a non-emotional, cold environment, here we can also talk about various deviations from society.

Symptoms of schizophrenia

A complex set of various symptoms of schizophrenia is conditionally divided into 3 groups. The first of these are positive symptoms. The word "positive" is used here not in the sense of "good", but the presence of signs that are completely atypical for a healthy person. The positive symptoms of this disease include hallucinations and delusions.

The second group includes disorganized symptoms, which manifest themselves in the inability of the patient to adequately respond to what is happening and think logically. For example, patients with schizophrenia have incoherent speech, as well as unexpected transitions from one chaotic idea to the next. Movement in such patients occurs at a slow pace, they constantly lose or forget things, repeat the same movements for a long time.

The third is formed by the so-called negative symptoms of schizophrenia, which are expressed in the absence of emotions or in their inadequate manifestation in relation to the situation, for example, inappropriate laughter. In patients with this type of mental disorder, lack of will, indifference, loss of desires, and lack of interest in life can be noted. They are often characterized by the polarity of emotions, as well as the ability to be in a state of immobility for a long time. Another sign of schizophrenia is the depletion of facial expressions in the patient, when emotions are not reflected on his face.

Schizophrenia - a disease or a feature?

Only a qualified psychiatrist can recognize the presence of schizophrenia. In ordinary life, it is impossible or very difficult to distinguish a person suffering from schizophrenia from a healthy person. For example, a patient may be the head of an enterprise, while he manages it not emotionally and rather harshly (due to a mental disorder). This not only benefits him, but also brings tangible income. Usually patients with schizophrenia choose a highly specialized or simple type of activity. But due to the fact that they develop in this narrow direction, they are able to achieve great success in the professional field.

If we turn to history, we can say that many famous personalities either suffered from schizophrenia, or had the makings of this mental disorder. Here we can recall Franz Kafka, Vrubel or Van Gogh. The unusual fate of the famous mathematician and schizophrenic John Nash was reflected in the film A Beautiful Mind. Being sick, the mathematician went through the hell of treatment, but was able to regain clarity of thought and return to scientific work and teaching, he received an award. However, he remained ill.

There is probably some connection between deviation from normality and creative thinking. It is no coincidence that schizophrenia is attributed to creative people, as well as brilliant personalities in art and various sciences.

Nevertheless, from the point of view of official medicine, schizophrenia is clearly a disease. This is due to the fact that it has deviations from a certain norm, proceeds chronically, its symptoms are associated with disorders of the central nervous system and brain, and one of the reasons for its appearance are genetic predisposition and neurobiological disorders.

The term "schizophrenia" is not in vain as "mind splitting" or "splitting of the soul." After all, one of the problems suffering from this disease is internal disharmony. This can be manifested in a mismatch of behavior (he is cruel, rude, insensitive to people, but shows a lot of warmth, tenderness and love to plants and animals), the appearance of various hallucinations and echoes of thoughts (talking to himself, sounding his own thoughts).

In order not to be exposed to the possibility of schizophrenia, a person needs to find integrity, balance and harmony in himself.

As a rule, a person with schizophrenia has an internal conflict, which is associated with an internal disagreement or suppression of some part that he does not accept. Not all suffering from this disease are brilliant, create and create. Many of them withdraw into their inner world and do not want anything at all. They stop caring about their appearance and health. Symptoms of the disease can lead to his isolation from society, from the opportunity to communicate with others and live fully.

Treatment of schizophrenia

The treatment of schizophrenia is reduced to medications in combination with psychotherapy. Of the medications, as a rule, antidepressants and antipsychotics are prescribed. The doctor in the process of treatment must develop an individual treatment complex that should help this particular patient.

The success of the treatment of this disease depends on the joint work of the doctor and the patient himself. Ideally, the doctor should be interested in helping the patient and win him over in such a way that he begins to tell him everything as it is.
The patient must comply with the prescription prescribed by the doctor, and most importantly, he must want to get rid of his illness. However, people with schizophrenia often refuse treatment because of the pressure exerted on them by loved ones.

The patient's lack of understanding that he is really sick is the main difficulty in his treatment. The most important thing here is to do no harm, to find the line between home treatment and hospitalization. After all, when a person is isolated from society, he can become much worse. It will be very difficult to return him to a normal life later.