Schizophrenia

Schizophrenia (“I split” + “mind, mind”) is a mental disorder characterized by a deterioration in the perception of the surrounding reality and significant social dysfunction.

Schizophrenia can be provoked by the long and persistent creation of schizophrenic situations, followed by punishment for inevitable slips. At the same time, the whole context is schizophrenogenic — i.e. it is pointless to treat a schizophrenic and let him go back to his family, because there the laws of communication will come into force again, in which he can be “right” only for “wrong” reasons, and the very possibility of indicating the existence of these laws will be forbidden by unspoken rules. Accordingly, after some time, such a patient returns to the hospital with the same diagnosis.

Even today, we know little about this disease. Most experts are inclined to believe that schizophrenia occurs due to improper metabolism (metabolism) in the brain.

The positive symptoms of schizophrenia include delusions, hallucinations, constant reflection, and introspection.

The symptoms of schizophrenia are divided into positive (additional signs that are absent in a normal person) and negative (reduction or absence of signs that are normal). According to modern scientific ideas, none of the following symptoms is mandatory in schizophrenia, however, certain combinations of them and their development over time, described in the International Classification of Diseases (ICD-10) in sections F2 *, with a high degree of certainty, allow diagnosing this mental disorder. The Russian legislation stipulates the mandatory use of the ICD-10 in clinical and expert practice. Psychiatrists must indicate ICD-10 codes in the medical history. After the introduction of the ICD-10 by order of the Ministry of Health N172 of 1992, the so-called anti-dissident diagnosis of sluggish schizophrenia completely fell into disuse in clinical practice, and the claims against Russia of various conventional human rights organizations were accordingly withdrawn.

. There are different types of delusions in schizophrenia, but the following are typical for schizophrenia.

• The patient believes (Kandinsky-Clerambault syndrome) that someone puts thoughts into his head, affects his body, makes him do things. In principle, we can conditionally speak about the formation of a certain subpersonality during illness, especially with strong and tormenting obsessions. It is likely that the personification of these obsessions as «an enemy that has taken root in the body» evokes such an assessment of his condition in the patient.
• The patient believes that his thoughts are being teleported to other people.
• In some cases, the patient can be sure that certain mafia structures have special equipment for reading and putting thoughts into him by means of radiobiological (axion, torsion, etc.) communication.
• The patient finds hidden messages addressed to him personally in books, periodicals, etc. In general, the patient constantly puts himself at the center of the universe and looks for some «signs» of his exclusivity in one form or another.

. Although hallucinations can be varied, hallucinations in the form of voices («voices in the head») are typically schizophrenic. Often the patient is able to distinguish voices in the head (unreal) from real sounds. Such «hallucinations» are called pseudohallucinations. Voice messages are often accusing or threatening. Sometimes voices order the patient to do something. In some cases, the patient can fulfill the order of the voices, obeying their will, although according to statistics this happens very rarely, and also depends on the nature of the voices themselves, the critical mood and the will of the patient himself. There are cases when cured patients told that they simply invented «telepathically communicating aliens» and other pseudo-hallucinations in order to entertain themselves and draw attention to their person.

. The desire to deal with the imagination, get to the bottom of the truth of what is happening, and get rid of the disease. This pushes many to study psychology and psychiatry, and quite often among schizophrenics there are people who are well aware of many issues in these areas. There are very frequent cases when the patient is simultaneously a psychologist or a psychiatrist. In addition, many patients can go into mysticism, the magic of the situation, and also look for the causes of the disease in their own sinfulness, apostasy, their own past, etc. On this basis, there is often an increased religiosity, a desire to find the right worldview. If in the countries of the post-USSR, among ordinary people, the percentage of believers is about 14 percent, then among those who “hear voices”, this percentage reaches 20 percent.

«. It arises due to the fact that any person in a conflict situation lives in a «combat» mode and is suspicious of everything around him, and also due to social prejudices about the social danger of the patient, which can confirm the patient’s mania, and his response actions can confirm prejudice.

Sometimes there is an extraordinary creative «fertility». An author with schizophrenia can sometimes seem to an inexperienced viewer (listener, reader, etc.) a very interesting author, very vividly combining the incongruous, singing about what others are afraid to even talk about, etc.

Sometimes there may be a kind of «religious insanity», which is characterized by extreme religious strictness in relation to others and the absence of such in relation to oneself. For example, a patient may try to kill a woman because she had an abortion, citing the fact that she is a «murderer», while he does not consider his own action to be murder.

On the other hand, the disease itself is not an undeniable sign of danger to others, although the mass media and the social environment can give people a perception pattern like “sick in the head means dangerous.” There are a lot of victimized people among schizophrenics, often there are witnesses of especially serious crimes, or people who are opposed to corrupt systems, and “hearing voices” in itself is a kind of fear, a phobia that is ousted by consciousness from the mental theater, and at the same time is constantly imposed on the victim in the form of semantic or auditory hallucinations. Hallucinations are often seen by healthy people in conflict situations.

Negative symptoms of schizophrenia include:

• Emotional dullness — narrowing (flattening) of the emotional sphere of the personality: weakening of love for relatives and close people, weakening of professional interests, loss of interest in previously beloved activities, weakening of lower emotions (pain sensitivity, food and sexual unconditioned reflexes). The appearance of emotional inadequacy, the appearance of a qualitative inconsistency of the emotional reaction with the stimulus that causes it, is also characteristic.
• Alalia — Poverty or complete cessation of speech.
• Hypobulia — weakening of volitional activity, characterized by weakness of motives, weakening of desires, narrowing of the range of volitional acts available to the patient.
• Abulia — complete lack of motives.
• Parabulii — perverted forms of activity, which include paramimia — pretentious facial expressions, parapraxia — perverted mannered actions, gait, postures, gestures.
• Atactic thinking It is characterized by the presence in the patient’s speech of uncoordinated, normally incompatible concepts. The appearance of such uncoordinated combinations is also called atactic closures. In the presence of atactic closures between sentences, blocks of phrases, they speak of reasoning (lengthy non-specific fruitless reasoning), in the presence of atactic closures between words within one sentence, they speak of atactic confusion (the extreme degree is schizophasia, “verbal okroshka”, when speech is an incoherent set of words ), with the penetration of atactic closures into the word, neologisms appear in the speech of patients, logorrhea is often observed.

Defect structure

Primarily a violation of the motivational-need sphere. The appearance of a significant gap between most motives and reality due to a violation of control over one’s own imagination.

Secondarily, a violation of cognitive activity and the operational side of thinking.

Thirdly, personality change. Like multiple identities and many phobias, it is iatrogenic. Usually the development of schizophrenia occurs approximately in the following way:

1. The appearance of the first wave of hallucinations or phobias due to disruption of work and sleep, conflicts, threats to life, drug use, tobacco or alcohol abuse, prolonged depression, passion for esotericism and magic, conscious analysis of dreams, and many other factors;
2. There is a very strong curiosity, a desire to understand the nature of hallucinations associated with the unusualness of what is happening. These questions «why» and «how», even without being verbalized, include the imagination of a person in active analysis, the role of a scientist, thereby starting a new stage of hallucinations.
3. In the event that a hallucination, as a fact, frightens a person, his logic forgets about the question “why and how” he himself asked, the relationship of the new stage of hallucinations with his own curiosity is lost for him, a sound thread of reasoning breaks, and he has an early or later, the belief in the obsession of these same hallucinations. A break in consciousness is characteristic of any phobias that block the understanding of what is happening and lead a person into a state of excitement necessary to suppress, fight the phobia itself.
4. The belief in the obsession of hallucinations causes a new wave of curiosity about what is happening, which is why a person is drawn to any knowledge that could explain it to him. First, he can ask the hallucinations themselves, or animated images, about who they are and what they are. Those. talk to your own imagination, demanding, pleading or asking for answers and advice. Secondly, in many cases, people in this state begin to trust their own intuition very much, although they might have been more skeptical about it before. This process can be characterized as active «listening», in which a person listens to any signal enough to get information from it, even when there is no information in it at all. In this case, a person does not understand either the nature of the origin of his own thoughts, or the nature of the thoughts that are imposed on him by a “sick”, “foreign”, “foreign” imagination. The more questions, the greater the temptation to understand. The desire to understand leads to the activation of animation zones, for the very reason that any question conjures up associatively the subject being asked about.
5. Due to complete immersion in internal processes, communication with the real world may be distorted, as a result of which symptoms of talking dogs may appear, the noise of cars and the laughter of people may have some other meaning, many sounds associated with ordinary natural phenomena, like dripping water from under tap or TV sounds, due to distortion, as well as an increased level of «listening», and the course of events begins to develop.
6. Some types of personality dissociation, or multiple identities, are characterized by the person’s belief that the voices are disconnected parts of his own personality, or even the result of sinfulness. But schizophrenia is characterized by the belief that voices can be a manifestation of external influences, such as telepathy, radiobiological communications, psychotropic weapons, the devil and demons, the impact of aliens and special services, etc. With the development of fear of these forces, the scenario of schizophrenia itself develops further. Under the influence of internal beliefs and fears, a kind of «Hell» begins to be born, in which bad «voices» mock the carrier of the disease. Typical maps of the development of events are conspiracies of mafias, special services, the Devil, aliens. More rare are the beliefs that electrical appliances have a mind and want to communicate with a person, or that it is the dead who want to reach out from other worlds, or the belief in the existence of parallel universes and worlds. It should also be noted that there may indeed be persecution by mafias, corrupt power clans, etc., but they do not know how to read minds, apparently.

It is characteristic that people usually suffer from schizophrenia when they leave the «social stream», i.e., after graduating from school or college, leaving all collective games, and not having a clear introspection, they ask themselves the primary question about their own imagination due to idleness or loneliness. If the disease were not so severe for so many people, it could be called nothing more than stupidity, or even a joke of nature. But, looking at an elderly woman who screams heart-rendingly “demons, demons, get out of my head!”, You understand that a stupid joke has become a curse for her.

Etiology

The origin and mechanisms of development of the pathological process in schizophrenia still remain unclear, however, recent advances in genetics and immunology give hope that the solution to this riddle, which worried generations of doctors, will be found in the coming years.

Troubled childhood?

In the past, the existential theory of R. Laing was popular. The author considers the reason for the development of the disease to be the schizoid personality accentuation that is formed in some individuals in the first years of life, characterized by a splitting of the inner self. In the case of progression of the splitting process over the course of life, the likelihood of a transition from a schizoid personality to a schizophrenic one, that is, the development of schizophrenia, increases. The theory is now considered unscientific.

Many studies suggest a hereditary predisposition to the disease, but twin estimates of this predisposition range from 11 to 28 percent. Currently, great efforts are being made to identify specific genes, the presence of which can dramatically increase the risk of developing schizophrenia. A 2003 review of related genes includes 7 genes that increase the risk of a later diagnosis of schizophrenia. Two more recent reviews state that this association is strongest for genes known as dysbindin (dysbindin, DTNBP1) and neuregulin-1 (neuregulin-1, NRG1), with a variety of other genes (such as COMT, RGS4, PPP3CC, ZDHHC8 , DISC1, and AKT1).

perinatal factors?

The environment also plays an important role, especially intrauterine development. Thus, mothers who conceived children during the 1944 famine in the Netherlands had many schizophrenic children. Finnish mothers who lost their husbands in World War II had more schizophrenic children than those who learned about the loss of their husband after the end of the pregnancy.

The role of the environment?

There is a lot of evidence showing that stress and cramped life circumstances increase the risk of developing schizophrenia. Childhood events, abuse or trauma have also been noted as risk factors for later disease development. In most cases, before the onset of hallucinations and voices, the patient is preceded by a very protracted and prolonged depression, or neurotic memories of childhood traumas associated with especially serious crimes (incest, murder). In some cases, there may be a persecution mania associated with the risky activities of the patient himself. If he is a criminal, then he has the belief that law enforcement agencies are monitoring him daily. If this is a good person, opposed to mafia or totalitarian systems, then he has the conviction that they are watching him, “listening” to his thoughts telepathically or with the help of special devices, or simply “bugs” are introduced everywhere.

Autoimmune disease?

Currently, there is more and more data indicating the decisive role of autoimmune processes in the etiology and pathogenesis of schizophrenia. This is evidenced both by studies on the statistical correlation of schizophrenia with other autoimmune diseases, and recent work on a direct detailed study of the immune status of patients with schizophrenia. The success of the autoimmune theory will mean the emergence of both the long-awaited objective biochemical methods for diagnosing schizophrenia and new approaches to the treatment of this disease that directly affect its causes and do not disrupt the thought processes of people who have been misdiagnosed with this disease.

Pathogenesis

Schizophrenia can begin at any age, but most often begins at 15-25 years of age in men, at 20-30 years of age in women.

Schizophrenia often comes in the form of seizures. Attacks are characterized by intense positive symptoms, and the intervals between them are mostly negative (positive symptoms may be mild or present only in an erased form: strange beliefs, etc.). Often there is only one attack in a lifetime. If there are negative symptoms, and positive ones are weak or absent, they speak of residual schizophrenia.

Over the years, the condition can improve significantly, but one cannot speak of a complete recovery, we are talking about the remission of the disease. A 1987 study showed that in patients with schizophrenia in the 1950s, in a third of cases the condition did not change significantly or worsened, in a third of cases it improved significantly, in a third of cases the patients recovered.

Forecast

The prognosis depends on how early treatment is started. In addition, the later the onset of schizophrenia, the easier the course of the disease: schizophrenia that began in childhood or adolescence is usually very severe, and in middle age it is mild.

Schizophrenia is not contagious and not fatal (there is a hypertoxic form of schizophrenia that can be fatal), although schizophrenics live on average 10 years less than mentally normal people. One reason is that schizophrenics often commit suicide (30% of all schizophrenics attempt suicide, 10% commit suicide; male schizophrenics commit suicide 3 times more often than women). Another reason is that schizophrenics smoke much more often than mentally normal people. There is also evidence that immunological changes in schizophrenia may be responsible for disease in other organs of the body.

Childhood schizophrenia caused by birth trauma sometimes resolves on its own during adolescence. This type of schizophrenia is also characterized by an improvement in the course of the disease when prescribing general stimulant drugs, such as nootropil.

Social adaptation

According to the degree of disability, schizophrenia is one of the most severe diseases. In a recent study of schizophrenia in 14 countries, it is ranked third in severity after quadriplegia (paralysis of the arms and legs) and senile dementia, and before paraplegia (paralysis of the legs) and blindness.

Diagnosis

There are currently no objective methods for diagnosing schizophrenia. The diagnosis is made on the basis of conversations with the patient and analysis of his behavior.

In Soviet psychiatry, the diagnosis was made on the basis of the following triad: emotional dullness, atactic thinking, hypobulia with parabulia. The fuzziness of the criteria gave rise in the USSR to the recognition of a special form — the so-called. Sluggish schizophrenia.

Atactic thinking is recognized through tests, including Rorschach tests (also known as inkblot tests) and tests with a choice of similar objects (small pictures should be arranged on the table in several rows). There is a well-known example when a subject chooses a shoe and a pencil from pictures with images of children, pets, clothes and various objects. This choice is motivated by the fact that they leave a mark.

Western psychiatry has developed clear criteria for mental illness, including schizophrenia.

The diagnostic criterion for schizophrenia, according to the DSM-IV-R, is a combination of the following:

• A. Brad. hallucinations. Disorderly speech (for example, frequent confusion of the topic or meaninglessness). Severely erratic or catatonic behavior. Negative symptoms, namely emotional ogu.e.nie, alogia or parabulia. Presence of at least two of the following symptoms for a significant part of the monthly interval (or less if treated successfully). If the delusions are bizarre (that is, highly inappropriate) or the hallucinations are in the nature of a voice commenting on the patient’s behavior or thoughts, or at least two voices talking to each other, one symptom is sufficient.
• B. Social/professional incompetence. For a significant portion of the time since the onset of the disease, the level of achievement in the field of work, relationships or self-care is much lower than before the disease, and if the disease began in childhood, the failure to achieve the expected level in the field of relations with people, work or school.
• C. Duration. Symptoms last at least six months. Out of this half year, for at least one month the symptoms satisfy criterion A (active phase), and for the rest of the time (residual and prodromal phase), there are negative symptoms or at least two of the symptoms of criterion A remain in an erased, attenuated form ( such as strange beliefs or unusual sensory experiences).
• D. Schizoaffective disorder and manic-depressive psychosis are excluded. Either there are no phases of depressive, manic or mixed episodes during the active phase, or their duration is short compared to the total duration of the active and residual phases.
• E. The reason is not drugs or medications or some non-mental illness.
• F. If the patient has suffered from autism or other developmental disabilities, a diagnosis of schizophrenia requires that significant delusions or hallucinations have continued for at least a month (or less if treated successfully).

Clinical forms of schizophrenia

Traditionally, the following forms of schizophrenia have been distinguished:

• Simple schizophrenia is characterized by the absence of productive symptoms and the presence of only schizophrenic symptoms proper in the clinical picture.
• Hebephrenic schizophrenia (may include hebephrenic-paranoid and hebephrenic-catatonic states).
• Catatonic schizophrenia (pronounced impairment or lack of movement; may include catatonic-paranoid states).
• Paranoid schizophrenia (there is delusions and hallucinations, but there is no speech disorder, erratic behavior, emotional impoverishment; includes depressive-paranoid and circular variants).

Now there are also the following forms of schizophrenia:

• Hebephrenic schizophrenia
• catatonic schizophrenia
• Paranoid schizophrenia
• Residual schizophrenia (intensity of positive symptoms is low)
• Mixed, undifferentiated schizophrenia (schizophrenia does not belong to any of the listed forms)

Difficulty in diagnosis

Since there are no objective diagnostic methods, doctors often disagree on the diagnosis. So, according to a 1995 American study, two psychiatrists only in 65% of cases make the same diagnosis in the case of a diagnosis of schizophrenia. In the USSR, according to Vladimir Levy, the situation was even worse: almost all mentally ill people were diagnosed with schizophrenia. Such a nosological unit as sluggish schizophrenia appeared, the main diagnostic symptom was a feeling of discomfort and depression.

Currently, objective methods for diagnosing schizophrenia are being developed. For example, in the Human Brain Research Group at the Department of Human and Animal Physiology, Faculty of Biology, Moscow State University. Lomonosov, studies are underway on the alpha brain rhythm of adolescents suffering from disorders such as schizophrenia.

Prevalence

Schizophrenia is equally common among both sexes.

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

Treatment

There are currently no effective treatments for schizophrenia. Of the drug methods, drugs of various groups of antipsychotics (haloperidol, chlorpromazine, etc.) or atypical antipsychotics (olanzapine, clozapine, risperidone, quetiapine, ziprasidone, aripiprazole) are always used. Side effects of antipsychotics include depression (in the case of haloperidol), tardive dyskinesia (tics, such as smacking; this side effect is not treated and does not go away even when the antipsychotic is discontinued), akathisia (restlessness, often with a hint of anxiety: the patient, for example, cannot eating normally — instead, he swallows a piece, runs around the room, eats a little more, etc.) and others. Atypical antipsychotics are no weaker in their therapeutic effect (and according to some sources, stronger) than antipsychotics and, unlike antipsychotics, do not lead to severe side effects, but are expensive, because they were recently discovered and the patent has not yet expired. Therefore, many schizophrenics in Russia are not able to buy these drugs.

Often prescribed together with antipsychotics proofreaders (for example, cyclodol), reducing side effects. Sometimes antidepressants are prescribed to fight depression.

Occasionally (because of their danger to life), insulin coma is used. Some researchers are trying to use psychotherapeutic techniques. But a paradox always arises: if the patient has a greater intellect than the doctor, then what is the use of this healing? And if the patient’s analytical abilities are not developed at all, then no, even sound reasoning from the outside world, can explain to him everything that happens to him from the inside. Occupational therapy is used as something that switches the patient’s consciousness from illness to external actions. It is ineffective, because sooner or later the patient’s consciousness will return back.

Forecast and expertise

The prognosis of the disease depends on the form, type of course, age and other individual characteristics of the patient, the nature of his profession. With a continuous-progressive type of course, patients are transferred to group II or I of disability, in rare cases of good therapeutic remission — group III, with a paroxysmal-progressive type — group III or II. In the paroxysmal-progressive type, recovery is theoretically possible after the first attack (with the complete absence of a defect and the absence of attacks in the future), but in this case the question arises of the correctness of the diagnosis of schizophrenia. Patients with schizophrenia who have committed an offense both in a state of psychosis and in remission, or who fell ill with schizophrenia during the investigation and / or trial, but before sentencing, as a rule, are determined by the court to be insane with their direction for compulsory treatment in psychiatric hospitals with a strict regime or general type (depending on the severity of the offense committed). Patients with schizophrenia are considered unfit for military service.

Schizophrenia in world culture

The story «The Demon of Contradiction» by E. A. Poe contains a very accurate and detailed description of the Kandinsky-Clerambault syndrome «from the inside», from the point of view of the patient. The patient personifies his obsessions as «the demon of contradiction.»