The main stages of the course of schizophrenia in different forms of the disease. Three stages of schizophrenia Who can get sick?

Table 27.1. Schizophrenia: symptoms of the first rank according to Schneider

Open mindedness- the feeling that thoughts can be heard at a distance. Feeling alienated- the feeling that thoughts, impulses and actions come from external sources and do not belong to the patient. Feeling the Impact- the feeling that thoughts, feelings and actions are imposed by some external forces that must be passively obeyed. Delusional perception- organization of real perceptions into a special system, often leading to false ideas and conflict with reality. Auditory hallucinations- clearly audible voices coming from inside the head (pseudohallucinations), commenting on the actions or pronouncing the patient’s thoughts. The patient may “hear” short or long phrases, indistinct muttering, whispering, etc.

Table 27.2. Stages of schizophrenia according to Conrad

Diaeresis Loss of unity of perception of the internal and external world; there is a feeling of loss of freedom, unrecognizability of the world (a variant of depersonalization) or a feeling of inability to communicate. Apophenia The loss of the unity of perception of the internal and external world reaches such an extent that the connection between inseparable concepts is broken; this leads to delusions and other paranoid symptoms. Apocalypse Complete destruction of the unity of perception, fragmentation of mental life and self-awareness (fragmentation of the “Ego”). Stage of consolidation and residual defect

Fish F. A neurophysiological theory of schizophrenia. J. Ment. Sci. 107:828-838, 1961.

Table 27.3. Diagnostic criteria schizophrenia(s)

The duration of the attack must be at least 6 months, including the prodromal and residual period. During this time, negative symptoms (illogicality, affective dullness, anhedonia, asociality, abulia and apathy) or two or more of the symptoms listed below in a mitigated form must be constantly present. During the same period, an acute phase should be observed lasting at least a month (may be shorter during treatment), in which two or more of the symptoms listed below are observed in expanded form. 1. Delirium. 2. Hallucinations. 3. Disorganization of thinking or speech (eg, incoherence, thought blockages, thought slippage). 4. Disorganized or catatonic behavior. 5. Negative symptoms (see above). These symptoms should lead to disruption of life (at home, at work, at school, in relationships with people) over a significant period of illness, and there should be a significant deterioration in condition compared to the initial one (before the attack). Both symptoms and associated disorders should not be caused by a physical illness, drug use or medicines, a manifestation of schizoaffective psychosis or affective disorder

(a) DSM-IV also has a classification of schizophrenia based on the nature of the course (continuous, paroxysmal) and its manifestations; in accordance with the last criterion, disorganized (disorganization of speech and behavior, smoothness or inadequacy of affects), catatonic (catalepsy or stupor, increased motor activity, negativism, mutism, stereotypies, mannerisms, echolalia and echopraxia), paranoid (delusions or hallucinations, without signs) are distinguished catatonic or disorganized form), undifferentiated (does not fit into the criteria of the three forms described above) and residual (in which the symptoms remain, but do not meet the full criteria) forms of schizophrenia. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Draft Criteria: 3/1/93. DSM-IV. Copyright, American Psychiatric Association, 1993.

Table 27.4. Conditions manifested by schizophrenia-like symptoms

Poisoning and vitamin deficiencies- Drug and narcotic psychoses (most often caused by amphetamines, cocaine, LSD, cardiac glycosides, corticosteroids, disulfiram), Alcoholic hallucinosis, Wernicke encephalopathy, Korsakov's syndrome, Bromism and heavy metal poisoning, Pellagra and other vitamin deficiencies, Uremia and liver failure

Infections- Syphilis, Toxoplasmosis, Viral encephalitis, Brain abscesses, Schistosomiasis, Neurological diseases, Epilepsy

Primary and metastatic brain tumors- Alzheimer's disease, Condition after encephalitis, Cardiovascular diseases, Heart failure, Hypertensive encephalopathy

Endocrine diseases- Thyrotoxicosis, Hypothyroidism, Cushing's syndrome

Hereditary and metabolic disorders- Acute porphyria, Homocystinuria, Niemann-Pick disease

Electrolyte imbalance- Diabetes mellitus

Collagenoses- Lupus arteritis of the brain

Table 27.5. Prognostic signs for schizophrenia

Table 27.6. Indications for hospitalization for schizophrenia

1. For protection purposes A. Protecting the life and reputation of the patient. b. Protecting individuals or society from the sick. V. Removing the patient from a harmful environment.

2. Diagnostic A. Observation. b. Special research methods (for example, CT/MRI).

3. Therapeutic A. Convincing the patient and his family to 1) start and continue treatment, 2) change their lifestyle. b. Drug treatment 1) complex treatment that is not possible in an outpatient setting, 2) intensive treatment with potentially toxic drugs or a treatment regimen that requires careful monitoring, 3) providing medications to patients who are in a state of confusion or who do not comply with medical orders for other reasons.

4 Family and social indications(currently rarely taken into account due to the high cost of treatment and the tendency to reduce hospitalization periods) 1) social rehabilitation, group psychotherapy (including restoration of social skills and responsibilities), involvement in a psychotherapeutic group, 2) alleviation of the situation in the family, study of family relationships in a calm environment. d. Treatment methods that are not possible outside the hospital (for example, electroconvulsive therapy)

Detre, T. P., Jarecki, H. G. Modern Psychiatric Treatment. Philadelphia: Lippincott, 1971.

Table 27.7. Indications for discharge for schizophrenia

Disappearance or significant relief of the symptoms that caused hospitalization; no danger to yourself or others. Significant reduction in manifestations that dramatically complicate life in society; the improvement is sufficiently sustained to be maintained in an outpatient setting. Everything that the patient could get from hospitalization he has already received; further hospital stay will not bring significant improvement. There is stable remission (even in the presence of residual symptoms). The patient is able to take responsibility for his behavior. Outpatient treatment provided. The patient perceives reality quite realistically and is able to reason soberly about his condition. Normal social adaptation and interpersonal relationships. Social behavior and neat habits are acceptable. The patient has a place to live. The patient is capable of independent work and can be employed. There is sufficient livelihood or source of support. The patient is able to comply with medical instructions - independently or with the help of loved ones. The patient is not involved in litigation. There is a history of repeated escapes during hospitalization. The patient urgently demands discharge - even against the advice of the doctor

Katz, R. C., Woolley, F. R. Criteria for releasing patients from psychiatric hospitals. Hosp. Community Psychiatry 26:33-36, 1975.

Table 27.8. Neuroleptics

Table 27.9. Side effects of antipsychotics(s)

Table 27.10. Drugs for the treatment of neuroleptic parkinsonism

Atropine derivatives- Benzatropine

Piperidine derivatives- Biperiden, Procyclidine, Trihexyphenidyl

H1 blockers- Diphenhydramine

Muscle relaxants- Orphenadrine

Table 27.11. Symptoms of late neuroleptic hyperkinesis

Tongue and facial hyperkinesis- Chewing movements, Smacking and licking of lips, Sucking movements, Movements of the tongue inside the mouth, Protruding tongue, Tremors of the tongue, Worm-like movements of the tongue visible on its surface, Blinking, Grimaces and facial spasms

Hyperkinesis of the neck and trunk- Spasmodic torticollis, Dystonic movements of the trunk, Hyperkinesis of the trunk

Choreoathetoid hyperkinesis of the limbs

Literature

Adler, L. A., Angrist, B., et al. Neuroleptic-induced akathisia: A review. Psycho-pharmacology 97:1-11, 1989.

Andreasen, N. C. Negative symptoms in schizophrenia: Definition and reliability. Arch. Gen. Psychiatry 39:784-788, 1982.

Arnold, O. H. Schizophrener Prozess und Schizophrene Symptomgesetze. Vienna: Maudrich, 1955.

Benkert, O., Grunder, G., Wetzel, H. Dopamine autoreceptor agonists in the treatment of schizophrenia and major depression. Pharmacopsychiatria 25:254-260, 1992.

Bleuler, M. A 23-year longitudinal study of 208 schizophrenics and impressions in regard to the nature of schizophrenia. In D. Rosenthal, S. Kety (eds.), Transmission of schizophrenia. Oxford: Pergamon, 1968, pp. 3-12.

Chouinard, G., Jones, B., et al. A Canadian multicenter placebo-controlled study of fixed doses of risperidone and haloperidol in the treatment of chronic schizophrenic patients. J. Clin. Psychopharmacol. 13:25-40, 1993.

de Leon, J., Peralta, V., Cuesta, M. J. Negative symptoms and emotional blunting in schizophrenia. J. Clin. Psychiatry 3:103-108, 1993.

Glazer, W. M., Kane, J. M. Depot neuroleptic therapy: An underutilized treatment option. J. Clin. Psychiatry 53:426-433, 1992.

Goff, D. C., Arana, G. W., et al. The effect of benztropine on haloperidol-induced dystonia, clinical efficacy and pharmacokinetics: A prospective, double-blind trial. J. Clin. Psychopharmacol. 11:106-112, 1991.

Goff, D. C., Baldessarini, R. J. Drug agents interactions with antipsychotics. J. Clin. Psychopharmacol. 13:57-67, 1993.

Gottesman, I. I. Schizophrenia genesis. New York: Freeman, 1991.

Grinspoon, L., Ewalt, J. R., Shader, R. I. Schizophrenia: Pharmacotherapy and psychotherapy. Baltimore: Williams & Wilkins, 1972.

Hogarty, G. E. Prevention of relapse in chronic schizophrenic patients. J. Clin. Psychiatry 3(Suppl.):18S-23S, 1993.

Kane, J. M. Dosage strategies with long-acting injectable neuroleptics, including haloperidol decanoate. J. Clin. Psychopharmacol. 6(l):20S-23S, 1986.

Kay, S. R. Positive and negative syndromes in schizophrenia. New York: Brunner-Mazel, 1991.

Keck, P. E., Pope, H. G., McElroy, S. L. Declining frequency of neuroleptic malignant syndrome in a hospital population. Am. J Psychiatry 146:717-725, 1991.

Liberman, R. P., Evans, C. C. Behavioral rehabilitation for chronic mental patients. J. Clin. Psychopharmacol. 5(3):8S-14S, 1985.

Lieberman, J. A. Prediction of outcome in first-episode schizophrenia. J. Clin. Psychiatry 3(Suppl.):13S-17S, 1993.

Marder, S. R. Depot neuroleptics: Side effects and safety. J. Clin. Psychopharmacol. 6(l):24S-29S, 1986.

Meltzer, H. Y (ed.). Novel antipsychotic drugs. New York: Raven, 1992.

Nordstrom, A. L., Farde, L., et al. Central D2-dopamine receptor occupancy in relation to antipsychotic drug effects: A double-blind PET study of schizophrenic patients. Biol. Psychiatry 33:227-235, 1993.

Romme, M. A. J., Honig, A., et al. Coping with hearing voices: An emancipatory approach. Br. J Psychiatry 161:99-103, 1992.

Shader, R. I., DiMascio, A., et al. Psychotropic drug side effects. Baltimore: Williams & Wilkins, 1970.

Shenton, M. A., Kikinis, R., et al. Abnormalities of the left temporal lobe and thought disorder in schizophrenia. N.Engl. J. Med. 327:604-612, 1992.

Stein, L. I. A system approach to reducing relapse in schizophrenia. J. Clin. Psychiatry 3(Suppl.):7S-12S, 1993.

Stephens, J. H. Long-term course and prognosis in schizophrenia. Semin. Psychiatry 2:464-485, 1970.

Task Force Report. Tardive dyskinesia. Washington: American Psychiatric, 1992.

Tupin, J. P. Focal neuroleptization: An approach to optimal dosing for initial and continuing therapy. J. Clin. Psychopharmacol. 5(3):15S-21S, 1985.

Waddington, J. L. Schizophrenia: developmental neuroscience and pathobiology. Lancet 341:531-538, 1993.

- chronic mental illness, accompanied by splitting of thinking and emotional processes - personality disorders, often ending in schizophrenic dementia. Schizophrenia is classified according to its forms, the development of delusions, the nature of its course, and its stages. There are three stages of schizophrenia - mastery, adaptation, degradation.

The development of the disease can be viewed from different angles:

1. The general course of the process is

1. According to the principle of Selye's theory of stress -

• mobilization of all resources;
• adaptation to new conditions;
• exhaustion - strength is running out, decompensation occurs (the body is not able to cope with its functions), irreversible changes occur.

1. Stages of development of productive symptoms –

• paranoid;
• paranoid, hallucinatory-paranoid;
• paraphrenic.

1. Clinical stages –

• first stage of schizophrenia (mastery);
• schizophrenia 2nd degree (adaptation);
• the last stage of schizophrenia (degradation).

First stage of schizophrenia: mastery

“Illumination” occurs, the discovery of new truths. The patient experiences a feeling of elation, omnipotence, or, conversely, feels a tragedy, “realizing” that everything is bad, life is over, and he is being pursued by enemies. There is no place for peace during this period. The patient rushes about in joyful excitement or horror.

With a gradual increase in symptoms, at first anxiety and fear predominate, the patient does not understand what is happening, is confused, does not know what to do - run or defend. According to his ideas and feelings, the world around him and he himself are changing: either he becomes a brave hero fighting enemies, or an insignificant sliver in the Universe.

With timely treatment, the patient can be returned to real life. If the course is unfavorable, the disease, quickly passing the second phase, goes into long-term degradation.

Second stage: adaptation

The patient gets used to the new condition. Productive symptoms (delusions, hallucinations) become commonplace. The patient learns to live simultaneously in the world of reality and illusions; a “double orientation” is observed: in the same person the patient sees a “villain” trying to kill him, and a close friend.

The condition at this stage is characterized by schizophrenic stereotypies - rocking, walking in circles, repeating the same gestures and phrases. The outcome of the stage depends on the patient’s condition: whether he is more comfortable in the real or fictional world. Choosing the second one can lead to a resistant, protracted course.

Third stage: degradation

The third stage of schizophrenia is characterized by flattening of affect, emotional dullness, productive symptoms fade away, and the collapse of mental functions, personality regression, and dementia come to the fore.

Causes of schizophrenia

The causes of the disease are not fully understood. Theories and factors leading to pathology are divided into:

Biological –

Psychological –

• psychodynamic theory - the contradiction between the conscious and unconscious leads to personality regression;
• behaviorist theory - “strange” behavior is explained by the patient’s expectation from people of certain reactions and rituals he has invented;
• cognitive theory – the patient’s distorted perception of his feelings and the attitude of others towards them;
• stress;
• features of personality type.

Social –

• influence of family upbringing;
• changes in the family of an adult - the birth of a child, divorce, death of a loved one;
• position in society - leadership position, unemployment;
• household problems.

IN recent years The biopsychosocial model of schizophrenia has gained recognition, according to which the formation of the disease is influenced by a combination of biological, psychological and social factors in different proportions.

Signs and symptoms

The symptoms of the disease depend on the form and nature of the course. The following forms are distinguished:

1. Simple. Such a person is said to be “strange.” Behavior at times is inappropriate to the situation, the patient quickly becomes exhausted, is selective in communication, and is often misunderstood by people. An increase in deficiency symptoms (flattening of affect, apathy, abulia) occurs without a psychotic stage. There are no delusions or hallucinations.
2. . The most common. A clear clinical picture appears at the age of 20–30 years.

1. . It begins violently in adolescence and proceeds acutely. Characterized by “childish” behavior - grimacing, antics, crawling on all fours. The teenager teases, makes inappropriate jokes, and is excitable. He talks a lot. Drives are disinhibited - food, sexual. There are no productive symptoms. The form is very difficult to treat.
2. Catatonic. It manifests itself either in the form of a catatonic stupor or agitation.

Features of the flow

Schizophrenia can occur:

1. Paroxysmal - progressive - periods of exacerbations are replaced by remissions (“light” intervals). The longer the remission, the more severe the attack can be. With each new attack, the signs of psychosis intensify and their course becomes more severe and prolonged. During the period of remission, there are no productive symptoms, but signs indicating the disease remain;
2. Continuously – has three forms:

3. Circular (recurrent) – cyclical course with alternation of manic and depressive phases with a psychotic component (delusions and hallucinations). It differs in the nature of remissions (full health in bipolar disorder and decreased mental functions in schizophrenia).

Treatment

It is currently impossible to completely cure the pathology. The tasks boil down to:

• lengthening periods of remission to several years, preventing relapses;
• eliminating productive symptoms, reducing negative symptoms;
• prevention of the transition of the process to the stage of degradation.

Drug, biological and psychotherapy are used.

Medication is carried out with neuroleptics, tranquilizers to stop attacks and relieve psychotic symptoms. During the period of remission, maintenance doses of antipsychotics and general restoratives are prescribed. For schizophrenic dementia in the degradation stage, nootropics are used.

Biological includes insulin comatose, pyrogenic and electroconvulsive therapy. These types are effective in acute psychotic conditions. It should be used with caution, taking into account the medical condition, age of the patient and the risk of side effects.

Psychotherapy is indicated during remission and includes art, sand and occupational therapy. Family therapy and trainings for relatives of patients are of great importance, during which they are explained the essence of the pathology and taught how to properly communicate with such a patient and care for him.

Forecast

The prognosis of the disease depends on the form, stage, time of onset, the nature of the course of the disease, the frequency and severity of attacks, the rate of increase in deficiency symptoms and timely treatment.

An unfavorable prognosis is observed in the hebephrenic form, a malignant continuous course, onset in adolescence, frequent attacks, and a rapid increase in deficiency symptoms.

According to statistics, a third of patients experience long-term remissions, a third have frequent relapses, and a third have a rapidly developing schizophrenic defect. In addition to medical care, the prognosis of schizophrenia is greatly influenced by the support of loved ones.

According to statistics, every hundredth person on our planet is diagnosed with schizophrenia. This is a very complex and still not fully understood disease. Regarding schizophrenia, there is still debate in scientific circles regarding the classification of forms and symptoms of the disease, the causes of its occurrence and methods of treatment.

However, it has been proven that the course of the disease in any form occurs with an increase in negative symptoms. All patients have a tendency towards impoverishment and impoverishment of personality. Since schizophrenia is a progressive disease, several stages of its development can be distinguished.

In what forms does the disease manifest itself?

In different forms of schizophrenia, the disease proceeds according to a special scenario. Let's look at the different forms of schizophrenia according to the International Classification of Diseases, Tenth Revision (ICD-10):

• Catatonic schizophrenia. This form is characterized by movement disorders: stupor, freezing in awkward positions, waxy flexibility, as well as negativism and echo symptoms. The patient experiences agitation with erratic movements. It occurs either continuously or in attacks and can begin at any age.
• Paranoid schizophrenia. This form of the disease is characterized by such manifestations as delusions, auditory and other types of hallucinations, and not clearly expressed emotional, volitional and speech disorders. The onset of the disease usually occurs in the 3rd decade of life. It can occur either continuously or intermittently.
• Hebephrenic schizophrenia. Begins in adolescence or early adolescence. This form is characterized by a malignant course with the rapid development of negative symptoms. The patient has a pronounced behavioral disorder, inadequate elevated affect, disrupted thinking and speech. The course of the disease is mostly continuous, but sometimes it can be paroxysmal.
• A simple form of schizophrenia. Usually starts with adolescence. It is characterized by a fairly rapid increase in negative symptoms in the absence of productive ones. It proceeds continuously without attacks.

What are the stages of the disease?

The course of schizophrenia of any form, like any other serious illness, can be divided into three stages: initial, adaptation and the final stage of degradation. At the first stage of schizophrenia, the body tries to mobilize its resources; the symptoms are still barely noticeable, but the person is aware of the changes occurring to him. At the second stage, exhaustion of the body occurs, the person gradually adapts to his condition. The third period of the illness is characterized by the complete destruction of his psyche. The duration and severity of these stages differ from each other in each specific case. Therefore, there is no consensus regarding the definition of boundaries different periods diseases. It often happens that it is difficult to recognize at what stage of the disease a person is, because with different forms of schizophrenia, symptoms can vary greatly. What is common to all patients is that with any form of the disease there is a gradual increase in negative symptoms, which over time lead to a personality defect. If the course of the disease is unfavorable, then the stages of mastery and adaptation are almost invisible, and the period of degradation is prolonged. Separately, we should highlight the periods of remission and relapse inherent in some forms of schizophrenia.

The first manifestations of the disease or the stage of mastery

The initial stage of development of the disease is characterized by not specific, not pronounced, but vague symptoms that are very easy to miss. Sometimes this can be mistaken for depression, nervous disorder, increased anxiety or other psychosomatic problems. If this happens to teenagers, they rarely pay attention to it, associating aggressiveness and irritability with adolescence. However, already at the first stage of schizophrenia, a person shows logic that is incomprehensible to ordinary people. The patient is often confused in concepts and priorities, and combines things according to non-existent criteria. Usually, this becomes noticeable, first of all, for close people. Initial stage Schizophrenia can last from several weeks to several years, depending on the form of the disease. One can only guess what is happening in the patient’s head at this time. He gradually immerses himself in the world of his visions and hallucinations. A person begins to focus on himself, imagining himself as a hero or a victim of circumstances. All this is accompanied by anxiety, fear, loss, the person feels that everything is changing. True, he thinks that changes happen to the world around him, not to him. Externally it looks like .

The second, acute stage is called the period of adaptation

Schizophrenia is usually diagnosed at this stage. It is during this period that new productive symptoms appear or existing productive symptoms become more pronounced. At this stage, you can notice that the patient is haunted by hallucinations, he begins to delirium, and confusion of speech and thoughts appears. For a person, all these phenomena of illness become something familiar, integral, and in his mind different worlds already coexist peacefully. At this stage of schizophrenia, the patient may begin to simultaneously love and hate the same person, and see people as terrible enemies or peaceful acquaintances. At this stage, it is common for a person to “stick” like an old record. He repeats words and phrases, gestures and facial expressions several times. The more severe the course of the disease, the more stereotypically the patient behaves. Negative symptoms intensify, a person’s thinking productivity decreases, and memory deteriorates. He gradually loses interest in society, stops taking care of himself, becomes lack of initiative and more apathetic. He is subject to strange fears, headaches and unusual experiences. The longer the period of exacerbation of the disease, and the more pronounced the symptoms, the more difficult the consequences for the patient. In the hebephrenic form, this stage occurs very quickly. It is during this period that it is extremely important to begin treatment so that the patient does not get lost in his illusory world forever.

The final stage of the disease is degradation

At the third stage, a person experiences emotional degradation. Signs of such emotional and intellectual dullness develop differently, depending on the form of the disease. A person at this stage burns out from the inside, his hallucinations are no longer so vivid, he is completely lost in space and time. At the stage of degradation, the integrity of his psyche is completely violated, his actions become inadequate. Habitual for healthy person no reactions. The patient is no longer able to explain his train of thought, his motives and aspirations. A person’s actions become illogical and contradictory, only formal abilities are retained. This period of development of the disease is characterized by emotional and volitional disorders of the highest degree. The person becomes completely weak-willed and extremely apathetic. All negative and productive symptoms are expressed very clearly and it is very difficult to recognize the real personality of a person among them. It is at this stage that a symptom such as autism with internal devastation appears. In any form, the period of degradation is difficult and can end in complete dementia. In terms of prognosis, this stage is extremely unfavorable for any course of the disease. Only proper rehabilitation can enable a sick person to exist in society.

Remission of the disease in various forms of schizophrenia

In some cases of schizophrenia, there are short-term improvements or long periods of return to normal life. This stage of the disease is called remission. Remission in some types of schizophrenia does not always mean recovery. The state of stopping the disease and its slow progression can also be considered remission. At this stage, the patient feels well and exhibits adequate behavior. Improvement occurs after the active acute stage of the disease. In some forms of schizophrenia, after remission, the condition may deteriorate again, that is, a return to the acute stage. Such situations are called relapse of the disease. An exacerbation of symptoms can be seasonal, when, for example, a patient relapses in the fall, and in the spring the negative symptoms weaken after a course of treatment and the person returns to normal life. Each cycle of exacerbation and subsequent remission in schizophrenia can be accompanied by less intense productive symptoms with effective treatment. According to statistics, approximately one in six patients is considered fully recovered and does not require further therapy. Even if he exhibits some symptoms and decreases his ability to work. Sometimes patients experience complete remission of productive and negative symptoms of schizophrenia and no further relapses of the disease appear for several years.

Different variants of the course of the disease

Schizophrenia is an ambiguous disease, therefore it occurs differently in all patients. The course of the disease can be mild, moderate or severe. The same form of the disease different people may differ in the type of its course. Let's look at the ways in which schizophrenia can develop:

• continuous course with a gradual increase in negative symptoms;
• the undulating course is characterized by periodic changes in remissions of schizophrenia and its relapses;
• a paroxysmal progressive course is characterized by the presence of repeated attacks against the background of a gradual increase in negative symptoms.

Let us consider in more detail the stages of development of different forms of schizophrenia for all types of illness.

Ongoing schizophrenia

With this type of course, negative symptoms continuously increase and ultimately lead to the premature death of the individual. Most often this is how it develops simple form schizophrenia, although other forms of the disease can also occur continuously. The patient gradually goes through all three stages of the disease without attacks, up to a complete personality defect. This type of flow, in turn, can take on different forms: sluggish, moderately progressive and coarsely progressive. With a sluggish form, a person can work all his life and be socially adapted, but is gradually diagnosed as schizophrenic. A low-progressive course is most often characteristic of a simple form of schizophrenia. According to clinical symptoms, it can be neurosis-like, psychopath-like, or erased paranoid. More quickly, mastery turns into degradation in moderately progressive schizophrenia, which, according to the clinical picture in typical cases, is paranoid. Grossly progressive schizophrenia occurs with a rapid increase in the defect, for example, over the course of a year or even several months. All forms of the disease can develop along this course.

Wavy or paroxysmal course of the disease

This is a good prognosis for schizophrenia, since productive symptoms are present. With this course, there are attacks and interictal periods. As a rule, in one patient all attacks are of the same type. The patient quickly, usually over a period of 6-8 weeks, goes through three stages of the disease, then remission occurs, and after some time an exacerbation occurs and everything repeats. This also includes the annual autumn deterioration of the condition. And a person can go through this throughout his entire life. whole cycle remissions and relapses. It happens that after a stormy stage of mastery, the patient returns to normal life for a long time. After each attack, the severity of the defect does not increase much. If applied effective treatment, then negative symptoms decrease. Such forms of the disease as hebephrenic, paranoid and catatonic can occur according to a paroxysmal schedule.

Paroxysmal progressive form of the disease

The main difference between this course of the disease is that with this variant of schizophrenia, the patient periodically experiences attacks, but, unlike the wave-like course, the defect also increases between attacks. In fact, this course of the disease can be represented as the superposition of paroxysmal schizophrenia on a continuously ongoing one. The patient experiences a gradual increase in negative symptoms, and the attacks may be different in nature each time. Over time, there is also a decrease in the intervals between such attacks. This means that, despite periodic remissions of the disease, this type of course of schizophrenia is extremely negative according to prognosis, since there is an increase in the defect and an increase in negative symptoms.

Forecast of the course of the disease

A disease as complex and ambiguous in its symptoms as schizophrenia sometimes causes a lot of controversy regarding its diagnosis, identification of causes and methods of treatment. It is very difficult to make predictions regarding the course of the disease in each individual person. However, this is very important, because a correct prognosis of the disease guarantees the correct treatment, which means a high quality of life for a person suffering from schizophrenia. If the patient is treated, the probability of exacerbation of the disease is no more than 20%. Otherwise, the probability of relapse increases to 70%, and the prognosis of the disease worsens many times over. For some people, the disease progresses continuously throughout their lives, however, if the treatment is chosen correctly, there is a 25 percent chance that the first breakdown will be the last, and there will be no more exacerbations. Support and understanding from family and friends helps to qualitatively influence the outcome of schizophrenia. Research shows that a negative, hostile attitude from others dramatically increases the risk of exacerbation of the disease. Every person with schizophrenia has a chance to live full life, if you provide him with the help he needs in time.

Guys, we put our soul into the site. Thank you for that
that you are discovering this beauty. Thanks for the inspiration and the goosebumps.
Join us on Facebook And VKontakte

No disease is shrouded in such a mysterious and mystical aura as schizophrenia. Unfortunately, this gives rise to an unimaginable number of wild misconceptions. Well, we propose to find out the truth: firstly, it is interesting, and secondly, speculation complicates the lives of the patients themselves, prevents them from socializing and makes them feel embarrassed about their illness.

Finally website I saved the most interesting thing - about how to recognize this disease and whether you should trust Internet tests in this regard.

Myth No. 1. The main symptom of schizophrenia is split personality

Still from the film “The Three Faces of Eve.”

The name of the disease is translated as “split of the mind,” and behind this there is not necessarily a split in the personality. That is, not all schizophrenics hear voices or become a container for several personalities.

Still from the film “The Sum of All My Parts.”

In fact, approximately 1% of the population suffers from it, which is not so small. Take, for example, hemophilia, which is on the lips of many. Its most common type, hemophilia A, affects one in 5,000 or even 10,000 men. In the case of schizophrenia, there are approximately 5 cases of the disease for every 1,000 people.

Myth No. 3. People with schizophrenia are unpredictable, which makes them dangerous to society.

Still from the movie "Benny and Joon."

Still from the film "The Fisher King".

Yes, it is hallucinations and false conclusions (delusions) that become the reason for a person’s strange behavior and a visit to a psychiatrist.

But hallucinations are relatively easy to treat these days due to the wide range of options available. effective drugs- antipsychotics. The main problem for patients is the symptoms, which are called negative: a decrease in any activity, reluctance to communicate, lack of emotions and autonomic disorders. Because of them, it is difficult for a person to contact people, maintain friendships and work.

Myth No. 5. Only schizophrenics hear voices

Still from the film "Pi".

If you sometimes hear voices in your head, this is normal, such auditory hallucinations occur in 5 to 15% of adults, and maybe more, since some do not admit it for fear of being considered crazy. This happens especially often when overtired, stressed, and before going to bed.

Myth No. 6. Schizophrenia is a life sentence

Still from the film "The Soloist".

It depends on your luck. Of course, there are people whom the disease completely knocks out of life, despite treatment, but they are a minority. According to statistics, 25% (and this is a lot) of patients experience the first and only episode of psychosis, and then live their entire lives without relapses and do not even need to take medications.

Other patients have to stay on pills, but they can count on remission for decades and live a normal life, work and family.

Still others will always experience mild disorders, which will also not particularly affect the quality of life.

Myth No. 7. Schizophrenics are geniuses. And in general, they are not sick at all, but simply different

Still from the movie “A Beautiful Mind.”

Does schizophrenia help with creativity? Here you can answer both yes and no. On the one hand, like any disease, schizophrenia can reduce a person’s quality of life (but not always, as we understood from the previous paragraph).

On the other hand, there are indeed similarities between the thought processes of patients with schizophrenia and creative people - they have few dopamine receptors in the thalamus, which reduces the degree of filtering of signals that go from the thalamus to the cerebral cortex. This can provoke bursts of creativity.

Even if this is so, then schizophrenia is a disease and, like any disease, it should not be romanticized.

Myth No. 8. Schizophrenia progresses quickly

Still from the film “Shutter Island.”

The disease progresses slowly, and you won’t notice it right away. The first signs often look quite innocent: difficulties in school and at work, problems with communication and concentration. Almost everyone can notice similar “symptoms”. Then a person may begin to hear voices, or rather, barely audible whispers. It is at this stage that the disease is best treated.

Doctors say it's severe physical illness occur in three stages:

1. At the first stage, the body mobilizes all resources.
2. On the second, balance arises, the body adapts to the disease.
3. On the third stage, exhaustion sets in, the diseased organ (or the entire body) ceases to cope with the “work”.

Diagnosis and treatment of schizophrenia should be carried out experienced psychiatrist .

The course of schizophrenia resembles the course of serious illnesses of the body. There are three stages of schizophrenia: mastery, adaptation and degradation. The severity and duration of these stages vary significantly.

First stage of schizophrenia: mastery

From the familiar, predictable real world, the patient moves into a distorted, phantasmagoric world of visions, hallucinations, unusual colors and unusual proportions. Not only is his world changing, he himself is changing. With the rapid course of schizophrenia, in one’s own eyes a person becomes a hero or an outcast, a savior of the universe or a victim of the universe.

If changes occur gradually, the first stage of schizophrenia may be dominated by anxiety, confusion and fear: something wrong is clearly happening with the world around us, people’s motives are not clear, but they do not promise anything good - you need to prepare either for defense or for flight.

The first stage of schizophrenia can be called a period of discoveries and insights. The patient seems to see the essence of things and the true meaning of events. There is no place for routine and calm in this phase.

The discovery of a new world can be wonderful (for example, with a feeling of omnipotence) or terrible (with the realization of the insidious plans of enemies who allegedly poison the patient, kill him with rays or read his thoughts), but it is impossible to calmly experience the changes.

It happens that after experiencing a bright, stormy phase of mastery, the patient completely returns to normal life. And with an unfavorable course of schizophrenia, short, almost imperceptible periods of mastery and adaptation are quickly replaced by a long phase of degradation.

Second stage of schizophrenia: adaptation

The patient gets used to the changes. The sense of novelty is lost. At the second stage of schizophrenia, delusions, hallucinations and other manifestations of the disease become commonplace. The illusory world no longer obscures reality. The two realities coexist more or more peacefully in the human mind.

This stage of schizophrenia is characterized by the so-called “dual orientation”: the patient can see in the neighbor an evil alien and, at the same time, a well-known Uncle Misha.

Regardless of the course of schizophrenia, the result of therapy largely depends on what the patient chooses: the real world or the world of illusions. If nothing keeps a person in the real world, there is simply no need for him to return to reality.

In addition, this stage of schizophrenia is accompanied by repetition of the same words, gestures and facial expressions that are not related to the current situation, stereotypical behavior - the patient walks in circles around the room, sits and sways while lamenting. The more severe the course of schizophrenia, the more stereotypical the behavior becomes.

Third stage of schizophrenia: degradation

In this phase, emotional dullness comes to the fore. The time of onset of the third stage depends on the form and course of schizophrenia. Signs of emotional and then intellectual degradation quickly develop in hebephrenic and simple forms of the disease.

Patients with catatonic and paranoid forms, especially with a favorable course of schizophrenia, can remain emotionally and intellectually intact for a long time.

At the third stage, the patient seems to burn out from the inside: hallucinations fade, the expression of emotions becomes even more stereotypical. Space and time lose their significance.

For any type of schizophrenia, the third phase is unfavorable in prognostic terms. However, thoughtful rehabilitation gives patients the opportunity to exist in society. In some cases (usually after severe emotional upheaval), a short-term or sustained return to normal life is possible.