Contents
What is schizophrenia?
Schizophrenia is a disease of endogenous origin (due to internal changes occurring in the body), characterized by a paroxysmal or continuous course, manifested in a person’s personality changes and accompanied by multiple productive symptoms. The fundamental difference between this disease and other mental disorders is that schizophrenia occurs on its own and is not associated with external factors. In medicine, you can find synonyms for the name of this disease – Bleuler’s disease, discordant psychosis, dementia praecox. Due to the variety of symptoms, doctors often talk about this disease in the plural, that is, about discordant psychoses.
In the mass consciousness, the understanding has strengthened that a schizophrenic is a mentally retarded or feeble-minded person. However, the level of intelligence of such people can be different: low, medium, high, and even very high. History knows many great personalities who suffered from schizophrenia, including world chess champion B. Fischer, Nobel Prize winner mathematician D. Nash, famous Russian writer N. Gogol and others.
Therefore, do not take this psychosis as an abnormality. Schizophrenia, in fact, is a special disorder of such mental processes as perception and thinking. A sick person with normally functioning memory and intellect has a brain that adequately perceives information. However, the cerebral cortex is not able to process these data correctly.
To understand how a patient with schizophrenia sees the world around him, you can turn to an example. Seeing green grass, a healthy brain will transmit this information to the cortex, where it will be processed. The result will be the following: this is a natural process for nature, which means the warm season. The output of the consciousness of a patient with schizophrenia will be somewhat different, although he will also see green grass. But he may think that someone painted it, that it is the creation of the hands of foreign beings, that it needs to be destroyed, etc. This is a distorted picture of the world, which is formed against the background of an incorrectly working consciousness. That is why, translated into Russian, the term “schizophrenia” in the final interpretation sounds like “split consciousness”.
Signs and symptoms of schizophrenia
It is worth distinguishing between two concepts – signs and symptoms of the disease, since they will differ in the context of this mental disorder. Signs are understood as only 4 areas of brain activity that have disorders. They are also called Bleuler’s tetrad. As for the symptoms, they are specific manifestations that characterize schizophrenia.
So, the signs of the disease are:
Associative defect or alogia. It is characterized by a lack of logical thinking, the inability of the patient to complete any dialogue or reasoning. Alogia is explained by the scarcity of the speech reserve, the absence of additional components in the speech. This is expressed in the parsimony of the dialogue, in specific, monosyllabic answers to questions that all the time require clarification. The patient is not able to think out the logical chain of the discussion. For example, a dialogue between two familiar healthy people looks like this: “Where are you going?”, To which the answer will be given: “To mother, it’s her birthday.” The answer of the schizophrenic will be the following: “To the mother”, which requires additional clarification from the interlocutor: “For what?”. The new answer will also be monotonous: “Congratulations”, which again requires clarification of the details: “Does she have any holiday?”. “Holiday,” a person with a mental disorder will answer. “Which one?”, the interlocutor will have to find out again, etc. That is, the patient’s thinking is not able to extend, build a logical chain of dialogue, since the patient does not foresee possible questions that seem to a healthy person to be a completely natural continuation of the conversation.
Autism. This sign is characterized by the distancing of a person from everything around, immersion in himself, in the world he created by himself. The interests of the patient are limited, the actions are monotonous, it is difficult for him to evoke a response. A person cannot build normal communication with the people around him. The patient completely lacks a sense of humor, he perceives all phrases literally. Such people think stereotypically, stereotyped.
affective inadequacy. This sign is characterized by an absolutely inadequate reaction to the events taking place around. So, at a funeral, the patient can laugh uncontrollably, and during the general fun at the birthday party, start sobbing. However, at the same time, external expressions of feelings do not correspond to internal experiences. That is, the patient experiences severe stress or fear, but at the same time laughs hysterically.
Ambivalence. This sign is manifested in the fact that a person simultaneously experiences absolutely contradictory feelings in relation to the same object. For example, a patient both loves and hates pasta, swimming, etc. It is worth distinguishing between emotional (contradictory feelings in relation to other people, events, objects), volitional (endless hesitation when it is necessary to make a specific choice) and intellectual (contradictory ideas that mutually exclusive) ambivalence. The combination of these signs becomes the reason that the patient withdraws into himself, loses interest in the world around him, and behaves ridiculously. Personality disorders are manifested in the emergence of new hobbies, for example, in a craving for philosophical reflection, for religious teachings, for a fanatical passion for a certain idea. Gradually, a person completely loses his ability to work, becomes asocial.
Positive symptoms of schizophrenia. In this case, the term “positive” does not carry the meaning of “good”. It in the context of schizophrenia means that the patient begins to show those symptoms that he had not observed before.
Positive symptoms of schizophrenia are characterized by the following features:
hallucinations, which, in turn, are divided into sound, auditory, olfactory, visual, tactile and taste. Most often, patients with schizophrenia suffer from auditory perception disorders, when the patient hears some voices, and his own thoughts seem alien to him. Visual images occur much less frequently; when they appear, they are combined with other types of hallucinations. At the same time, the person himself does not perceive them as a fruit of his own imagination and treats them with complete seriousness;
Illusions when the patient sees the real object incorrectly. That is, looking at the table, a person sees a chair, looking at a shadow, sees a living object, etc. At the same time, illusions and hallucinations are different symptoms;
Delirium, which represents certain thoughts, conclusions, ideas, but they are absolutely divorced from the surrounding reality. Delusions may occur on their own, or may be the result of hallucinations. Variants of delirium can be very diverse. Most often, a schizophrenic suffers from delusions of persecution, when it seems to him that he is being constantly watched. In addition, there are delusions of influence (hypnosis, harmful rays, etc.), pathological jealousy, self-accusation, hypochondriacal (belief that one has a disease) and dysmorphophobic (belief that one has some kind of disadvantage);
Inadequate behaviorwhen a person behaves inappropriately for a particular situation. At the same time, the patient can be depersonalized when it seems to him that his body parts do not belong to him, his relatives are not his relatives, etc. Derealization also occurs when details insignificant for a healthy person are hyperbolized, which makes their perception distorted, unreal ;
Separately, it is worth highlighting the strongest manifestation of inappropriate behavior – catatonia. The patient at the same time begins to make erratic movements, freezes in unnatural and awkward poses for a long time. It is very difficult to get him out of such a stupor, as the person trying to help runs into resistance. Moreover, the muscle strength of schizophrenics is quite large. As mental excitement grows, such people begin to dance, jump, move quickly and perform other meaningless actions;
Another striking symptom of inappropriate behavior is hebephrenia., which manifests itself in excessive gaiety, laughter, laughter. At the same time, the situation may not at all set you up for a cheerful mood;
Disorders of thinking and speech. Often this is expressed in long, incoherent and fruitless reasoning. Moreover, it is not important for the patient himself whether the interlocutor understands his monologue, the process of philosophizing itself is important. Such people pay great attention to trifles, slip from one reasoning to another. In the most severe cases, schizophasia is observed, which is characterized by absolutely incoherent speech, since the patient’s thoughts are expressed in the form of an uncontrolled stream of words;
intrusive ideas, which constantly arise in the mind of a schizophrenic patient against his will. A person may be preoccupied with the meaning of life, climate warming and other global thoughts. He is very worried about this, and he cannot stop thinking about this topic.
Negative symptoms of schizophrenia. These symptoms represent qualities lost by a person. They were present until the manifestation of the disease, and then gradually began to fade away. Negative symptoms are manifested in the loss of physical activity, limited range of interests, lack of initiative, etc.
The negative symptoms of schizophrenia are characterized by the following features:
Difficulties in finding the right solution to any problem;
Frequent mood swings;
Autism, the patient strives for loneliness;
Loss of will;
Passive behavior;
Apathy towards the outside world;
emotional poverty;
Disorders of thinking, attention and speech. Vocabulary can only be replenished with fictitious expressions known to him, often a patient with schizophrenia repeats the same phrases, gives incomplete answers to questions, abruptly stops during a monologue, speech can be completely incoherent;
Low physical activity;
Effective flattening. It is expressed in the fact that a person shows indifference, sometimes cruelty and selfishness towards other people. It can be indifferent to the death of a loved one, be very offended by a common phrase. As the disease progresses, this symptom either makes the patient aggressive and angry, or excessively complacent and stupid. However, in schizophrenia there is always a tendency to overeat and masturbate;
Inability to maintain a dialogue;
Lack of initiative;
Violations of the sequence of actions algorithm;
Low level of self-control;
Dissatisfaction with life due to the inability to enjoy it. This symptom is called “anhedonia”, the schizophrenic loses the opportunity to enjoy elementary joys, for example, a walk in the fresh air, delicious food.
Lack of interest, low motivation and self-control cause patients to stop monitoring their appearance and do not follow basic hygiene rules. As a result, they look untidy, neglected, cause a feeling of disgust.
The depletion of the energy potential leads to the fact that patients eventually become disabled.
affective symptoms. The patient is always in a bad mood. It can be expressed in different ways. For example, he is overcome by thoughts of suicide, he is engaged in self-flagellation, falls into depression.
Disorganized symptoms. They echo positive symptoms, representing their special variety. They are expressed in confused, disorderly speech, in chaotic behavior and thinking.
Typical syndromes inherent in all patients. They are made up of several positive or negative symptoms. There are certain combinations that are most often found in such patients.
The very first signs of schizophrenia
isolation from society. A person who develops schizophrenia begins to avoid communication with family and friends. He prefers to spend time alone with himself. As the disease progresses, he will increasingly self-isolate. Start skipping school or work. The patient loses interest in his favorite activities, hobbies, delicious food, watching movies, etc.
Serious errors in hygiene. Non-observance of hygiene skills can be the first signal of a developing disease. The fact is that it is difficult for a sick person to perform simple actions. He begins to slowly brush his teeth, wash himself, take a long bath. This is due to apathy, self-forgetfulness and emotional burnout. The situation is aggravated by isolation from society.
Obsession with one idea. People suffering from schizophrenia become obsessed with mysticism, esotericism, religious trends, etc. Experts point out that patients have a tendency to religious extremes. Hallucinations are another symptom of the disease. This information was published in 2014 in the Indian Journal of Psychological Medicine. Scientists believe that these signs are due to the departure of consciousness from reality and paranoia. If at an early stage in the development of pathology, the enthusiasm for religion is not so noticeable, then as it progresses, a person can completely immerse himself in thoughts about mystical creatures, spirits and other non-existent evil spirits.
Sharpness of movements. Involuntary movements in the early stages of the development of the disease appear in all patients with schizophrenia. Their facial expressions become too active, the corners of the mouth may tremble, and blinking, on the contrary, slows down. Not always activation and sharpness of movements are signs of a developing disease. Sometimes they are simply characteristic of a particular person from birth. You need to be wary in the case when facial expressions are activated suddenly. Other symptoms of the disease include twitching of the limbs, which may resemble a tremor.
Hallucinations. Hallucinations in people with developing schizophrenia are common. They can involve all the senses. The most common are auditory hallucinations. They are diagnosed in 70% of cases. Patients indicate that they hear extraneous voices. Patients experience memory loss, impaired concentration, confusion. It begins to seem to a person that the thoughts that arise in him belong to other people or beings.
Causes of schizophrenia
There are several theories for the development of this disease. The approaches are quite diverse, among the most well-known hypotheses of the origin of schizophrenia are the following:
neurotransmitter theory. The dopamine concept boils down to the fact that the disease begins to develop due to an increase in the concentration of the hormone dopamine in the body. It stimulates neurons, which begin to produce more impulses, which causes disruption of the brain. Based on this theory, patients are treated with drugs that block receptors responsible for the production of dopamine;
Serotonin theory It is based on the fact that serotonin receptors work excessively actively, which leads to increased production of this hormone and insufficient transmission of the nerve impulse. Therefore, some new antipsychotics contain substances that affect the production of serotonin;
Noradrenergic theory indicates the involvement in the development of the disease of the hormones adrenaline, dopamine and norepinephrine, for the production of which the noradrenergic system is responsible;
Dysontogenetic theory. It is based on the fact that a person initially has structural anomalies in the structure of the brain. As a result of a number of factors, decompensation of these structures occurs, which causes the development of schizophrenia. Toxic substances, viruses, bacteria, genetic disorders become detrimental to the brain. Adherents of this theory do not exclude the presence of people at risk, which brings the dysontogenetic hypothesis closer to hereditary;
psychoanalytic theory. According to this hypothesis, the disease begins to develop against the background of a split personality. At the same time, internal self-awareness, the predominance of one’s own “I” begins to prevail over external circumstances, suppressing them. When the surrounding reality is perceived by the patient as a threat to his existence, he seeks to withdraw into himself. Misunderstanding of society in this case causes further alienation;
The theory of predisposition (constitutional and hereditary). The fact that the disease can be transmitted from parents to children is evidenced by many facts, among which statistics play an important role. So, when one parent is sick, the child runs the risk of schizophrenia in 12% of cases, and when both parents are sick, the risk increases to 40%. In addition, in identical twins, the disease will show the same signs by 85%, and in fraternal twins by 20%. However, scientists have not yet been able to find the gene for schizophrenia. However, certain chromosomal combinations have been identified that prevail in all patients;
constitutional theory assumes that a certain organism has specific characteristics. For example, this is the ability to respond to stress factors, the nature of a person, and body features. Also, adherents of this hypothesis put forward their own concept of “schizoid temperament”. Such a person is characterized by certain traits: suspicion, rejection of the outside world, etc.;
Theory of autointoxication and autoimmunization. Adhering to this hypothesis, scientists argue that the disease is caused by the poisoning of the body by the products of protein metabolism that have not undergone complete cleavage. Among the substances that pose a threat, they emit ammonia, phenolcresols and others. In addition, an additional negative factor is the periodic oxygen starvation of the brain, against which the processes occurring in it are aggravated;
cognitive theory. It is based on the fact that a person begins to experience strange sensations due to a number of biological factors. Trying to share your experiences and feelings with relatives causes misunderstanding. This leads to the fact that a person closes in himself and ceases to contact the outside world.
Stages of schizophrenia
The disease slowly passes through several stages of development. There are four of them:
primordial stage, on which the basic personal characteristics of the patient begin to change. The person becomes more suspicious, his behavior changes, becomes somewhat inadequate.
prodromal stage. The patient tries to isolate himself from the world, is protected from contacts with parents, friends, loved ones. The person becomes more distracted, uncollected, experiences difficulties at work and in the performance of household chores.
Stage of the first psychotic episode. At this time, hallucinations occur, delirium appears, the patient begins to pursue obsessive ideas.
remission stage. A person completely disappears all the symptoms of schizophrenia. This time period can be either long or short. After a temporary remission, the patient again has an exacerbation stage.
Types and forms of schizophrenia
It is customary to distinguish seven types of the disease, each of which is characterized by a certain clinical picture:
hebephrenic;
Paranoid;
catatonic;
undifferentiated;
residual;
Simple;
Post-schizophrenic depression.
Forms of schizophrenia are distinguished based on how the disease progresses:
Continuously flowing;
recurrent;
Paroxysmal-progredient;
Sluggish;
Febrile (accompanying an increase in body temperature);
Protracted pubertal schizophrenia;
Children’s.
paranoid schizophrenia
This type of illness 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.
Sluggish schizophrenia
There are many names for this type of disease, for example, sluggish schizophrenia is often called non-psychotic, mild, sanatorium, etc. The symptomatology of this type of disease is different in that personality disorders and an increase in the clinical picture do not occur over time. The patient is not delirious, does not suffer from hallucinations. Among the main symptoms of the latent form of the disease: asthenia, derealization, depersonalization and neurotic disorders. After an inconspicuous debut, it is replaced by a manifest period with more vivid symptoms of the disease, which, in turn, is replaced by stabilization of the condition for a long period of time.
Manic schizophrenia
The patient suffers from obsessions and delusions, among which persecution mania prevails. For hours, a person talks in verbal form about being surrounded by enemies, being followed, etc. In modern medicine, they no longer talk about manic schizophrenia, since it was decided to separate it into a separate form of mental disorder – into manic-depressive psychosis.
Hebephrenic schizophrenia
The patient has disorders of thought processes and emotional disturbances. Such people are characterized by frequent and abrupt mood swings, they are frivolous, fussing needlessly, and talk a lot. Delusions and hallucinations are most often absent.
Hidden schizophrenia
The illness is mild. Her debut, which usually falls on adolescence, goes unnoticed by others. The clinic is diverse, but dimly expressed. Patients are asthenic, sometimes fall into hysterics, may suffer from paranoia or hypochondria.
However, it is possible to determine that a person has latent schizophrenia by the fact that he will always have at least one of these three signs:
Oddities of behavior, awkward clothes, angular movements, sloppy appearance, descriptive speech with turns unusual for a healthy person (Verschroben);
The presence of very important ideological thoughts, which he constantly shares with others, tries to implement them, is always on an emotional upsurge, but not a single idea gives a productive result (pseudo-psychopathization);
The patient is passive, constantly wants to stay within the house, there is no desire to do anything (dynamic devastation).
hereditary schizophrenia
As for the possibility of transmission of the disease by inheritance, most doctors are of the opinion that this is quite real. If there was no relative with a similar disease in the immediate environment, then the risk of a person developing schizophrenia does not exceed 1%. As for the line of transmission, no such pattern was identified, the risks are equally preserved for both men and women.
Diagnosis of schizophrenia
To make a diagnosis, a psychiatrist will need at least six months to observe the alleged patient. The clinical manifestations of the disease are recorded, they are compared with the criteria developed by the UN and the American Psychiatric Association.
So, according to the ICD, the patient must have at least 2 signs from the criteria of the first rank:
Brad;
Crazy idea;
Hallucinations (auditory);
The sound of thoughts.
In addition, a person must meet the criteria of the 2nd rank:
Weak hallucinations, constantly pursuing the patient;
A break in thoughts, which is clearly seen in speech;
Signs of catatonia;
Several negative symptoms;
Disorders in the behavioral sphere.
In addition to the previous diagnostic methods, there are evaluation criteria for DSM-V. They suggest the presence of 2 or more symptoms in a patient (manifested for 30 days or more):
Hallucinations;
Brad;
Catatonia;
negative symptoms;
Disorders of thinking and speech.
It is important to differentiate schizophrenia from other neurological disorders. This allows you to make additional tests and techniques, as well as careful monitoring of the patient.
How to treat schizophrenia?
The main goal of the therapeutic effect is to establish a stable remission, the maximum delay in the onset of negative symptoms. During the period of exacerbation, the patient must be hospitalized so that he can receive adequate and timely assistance. This will reduce the risk of developing psychosis and reduce its possible complications.
When the acute period is over, the person can be taken away by relatives and friends. They help a person go through the rehabilitation stage, which helps prevent the early development of the last stage of the disease. To do this, there are various cognitive training, occupational therapy. The socialization of the patient is necessary, relatives of a person with schizophrenia should receive maximum information on how to properly organize the patient’s life.
Naturally, for the full treatment of the disease, medication is necessary. Antipsychotic agents are used, which have a diverse composition and have a wide spectrum of action.