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Manic-depressive schizophrenia. How to distinguish schizophrenia from prolonged depression? My depression turned into schizophrenia

In psychiatry, people often wonder how to distinguish depression from schizophrenia. These psychological disorders are similar, in addition, there are cases when they are present in a person at the same time.

For example, depression in schizophrenia in some cases is an integral symptom of the disease.

But depression can also occur on its own.

Cardinal differences between depression and schizophrenia

Both depression and schizophrenia are psychosocial disorders that contribute to a person's withdrawal from society and the world around them.

Schizophrenics most often exhibit abnormal social behavior and may not perceive reality due to strong hallucinations. Along with hallucinations, patients have a disorder of the thought process, catatonia and paranoia.

Depression is a long-term psychological disorder, the main symptom of which is a persistent low mood. In addition, with depression, a person may feel tired, anxious, guilty, helpless, and sad.

Symptoms fundamentally distinguish depression from schizophrenia. The key difference between these 2 concepts is that with depression there is necessarily sadness, gloominess, bad mood and unnatural pessimism, while with schizophrenia such signs may not be present. The patient may not have feelings of sadness, depression and pessimism. These are the defining signs of depression.

In addition, schizophrenia is a broader concept in relation to depression. Depression may be a symptom of this disease.

Thus, to determine which mental disorder is present in the patient: depression or schizophrenia, you need to carefully study the symptoms.

Depression in schizophrenia and depressive schizophrenia

According to research, schizophrenics are more likely to suffer from depression than others. Most patients experience sadness and a feeling of depression. Depressive symptoms are equally common in men and women.

If depression can stop during schizophrenia, then in the depressive form of schizophrenia it is the determining factor.

There are a number of factors that can contribute to the occurrence of the depressive form of this disease:

Diseases. Depressive symptoms can be caused by certain physical conditions, such as thyroid disorders or anemia.
Side effect. Side effects of medications can also cause severe mental disorders. This applies to antibiotics, antidepressants, and antiallergic drugs.
Schizoaffective disorder. With this type of disorder, depression will manifest itself along with hallucinations and paranoia.
Drugs. Drugs, including cocaine and cannabis, will cause feelings of depression, sometimes lasting for several days after taking them.
Loneliness. 3/4 of people with schizophrenia experience loneliness. The causes of loneliness may be due to psychological factors. For example, this may be due to a lack of communication skills or low self-esteem. For some people, loneliness can become a chronic problem. It can lead to self-destruction and suicide, and negatively affect the personal qualities of perseverance and will.
Despair and disappointment. Schizophrenia often appears during adolescence. At this time, teenagers are psychologically vulnerable. Disappointment from unfulfilled hopes and strong emotions experienced provoke the emergence of mental problems.
Life shocks. Life events such as bereavement can lead to severe stress, psychosis, and depressive schizophrenia. Increased sensitivity to stress can cause people to completely withdraw from society.

Depression and schizophrenia are potentially dangerous disorders, so it is important to identify their symptoms early.

Symptoms to see a doctor

With different forms of schizophrenia, symptoms may vary, but it is better to consult a doctor immediately after identifying the following symptoms:

Weight loss.
Feeling empty.
Lack of motivation and energy.
Slowness of speech and movements.
Insistent thoughts of death and suicide.
Sleep disturbance.
Great nervousness and anxiety.
Constant fatigue.
Feelings of worthlessness and guilt.
Constant feeling of sadness.
Lack of interest and pleasure in life.
Poor concentration.
Low self-confidence.
Pessimism.
Loss of appetite.
Loss of libido.
Hallucinations.
Paranoia.

When talking with a patient, the doctor should find out the following:

How does a person feel about personal hygiene?
Is he excited or confused?
Does his mood match his facial expression?
Is the patient willing to maintain eye contact?
How fast is his movement and speech speed?
Does he feel depressed or, on the contrary, does he seem nervous?
Does he have self-esteem?
How does he feel in the company of people he doesn’t know?
Does the patient remember his name?
Can he recall in his memory what happened to him throughout the day or week?
Does the patient have paranoia?
Has he ever had suicidal thoughts?
Has the patient used alcohol or drugs?
Does he have a desire to withdraw from society?

These questions during the initial conversation will help establish the presence and severity of a mental disorder. If there are reasons for concern, to confirm the diagnosis, the doctor may prescribe an MRI, conduct a neurotest, or duplex scanning.

People with schizophrenia are 13 times more likely to commit suicide than ordinary people. They may abuse alcohol or take drugs.

Remember that contacting a doctor when symptoms of mental disorders appear can not only protect a person from health problems, but in some cases, save life.

Treatment with potent drugs finally gave results. For the second month, my husband (daughter, uncle, father...) has no hallucinations and his interest in life has gradually begun to awaken. The relatives had just breathed a sigh of relief and thought about the magic word “remission,” when one disgusting morning a former patient of the psychoneurological dispensary again started talking about the frailty of existence. Don’t rush to jump to conclusions about relapse Dementia praecox . Approximately 30% of patients with schizophrenia, during the period of remission, are diagnosed with a depressive episode, which is a direct consequence of this disease. In the early 80s, this mental disorder was allocated to a separate section of the ICD, where it was assigned code F.20.4 and given the definition of “post-schizophrenic depression” (PSD).

Post-schizophrenic depression. Mechanisms of development and causes of occurrence

Doctors, when asked about the pathogenesis of PSD, shrug their shoulders in bewilderment. They don't have clear answers, but there are several plausible theories:

Theory 1. The disorder is the result of the action of neuroleptics, in particular, aminazine. The side effects of this drug indicate that it can cause depression and neuroleptic syndrome. Why do they continue to appoint him? It’s just that chlorpromazine, due to its sedative effect, is considered the most powerful antipsychotic, which also has the widest therapeutic range.
Theory 2. Post-schizophrenic depression is endogenous. It is assumed that the emotional personality disorder was present before it was masked by the delusions and hallucinations of schizophrenia. When acute psychosis subsided, depression came to the fore.
Theory 3. PSD is a transitional stage of remission, which is generally characterized by positive dynamics. Residual signs of psychosis are caused by stress due to the transition to outpatient treatment, job search, and change of daily routine.

Circumstances contributing to the development of the disease:

Social insecurity and stigma (label “schizophrenic”).
Hereditary predisposition to depression.
Tense situation in the family circle. The patient's relatives feel anger, helplessness, guilt, and ostracism from friends and neighbors. Part of this moral burden is voluntarily or involuntarily transferred to the shoulders of the patient with PSD.
In the “risk zone” are young men 25-30 years old and women 50-55 years old (menopause).

Symptoms of the disease

PSD occurs after the most severe symptoms of schizophrenia (delusions, hallucinations, thought disorders...) cease to dominate the clinical picture, but some of the signs of the disease continue to persist. It could be:

Eccentric behavior that does not correspond to generally accepted norms.
Incoherent and fragmentary speech. A person is not able to create associations and gets confused in individual concepts and images.
The circle of communication is limited to 2-3 people - most often these are the patient’s relatives who are accustomed to his style of communication. Emotional coldness may manifest towards strangers, even to the point of aggression. The lack of communication is compensated by conversations with imaginary people or with oneself.
Low physical activity, loss of interest in life, apathy. The condition worsens in the morning or before bed.
Increased anxiety, suicidal thoughts.
Depersonalization and derealization.

PSD can present as one or a combination of symptoms. Depending on their “set,” the disease can occur in an anxious, hypochondriacal, depressive-apathetic, asthenic-depressive or depressive-dysthymic variant. Treatment is selected according to the clinical picture.

About diagnostics

The diagnosis of “post-schizophrenic depression” can only be considered if at least one of the symptoms of a depressive episode has been present in the patient’s behavior for the last two weeks (see “Symptoms”). The initial prodromal period of schizophrenia and PSD are very similar to each other, and only a qualified specialist can distinguish between them. It is not difficult to cope with depression, while schizophrenic delusions and hallucinations tend to “grow” into a person over time and it becomes much more difficult to treat them.

Examination of a patient with PSD includes the following steps:

Consultation with a psychotherapist. If necessary, conversations with a therapist and neurologist are scheduled.
Fluorography, general blood test, urine test.
To exclude concomitant somatic or neurological diseases, additional studies are prescribed: cardiogram, electroencephalography, CT scan of the brain.
A clinical study is carried out, including collecting anamnesis, observations and conversations with the patient.

Based on the diagnostic results, a decision is made on hospitalization. A hospital is an extreme case, where a patient is sent if he becomes dangerous to others or shows suicidal tendencies. PSD is mainly treated at home or on an outpatient basis.

Treatments for a depressive episode

Therapy can last from a month to two, depending on the patient's resistance to medications and social factors.

Drug therapy

Antidepressants (AD):

Amitriptyline. Popular new generation AD. Increases the level of serotonin, norepinephrine. Has a powerful sedative and analgesic effect. Contraindicated in many heart diseases. Concomitant use of amitriptyline and MAO inhibitors can lead to the death of the patient.

Imipramine, milnacipran. Used for the treatment of PSD of the depressive-apathetic type.

- fluvoxamine. It has both antidepressant and stimulating effects. Well tolerated, has significantly fewer side effects than the above mentioned ADs.

Tranquilizers:

Diazepam, sibazon, relium. Reduce stress and fears, help with insomnia.

Neuroleptics

Haloperidol, triftazine, risperidone. “Classics” of psychotropic drugs. Prevents hallucinations, strong antiemetic. Prescribed for severe forms of PSD.

Physiotherapy

Zigzag technique. For several days in a row, the patient is given the maximum permissible dose of antidepressants (AD), and then their use is abruptly stopped. Used to overcome resistance to psychotropic drugs.
Laser therapy. The flow of quanta, affecting the neurovascular bundles and the patient’s brain, has a sedative effect, relieves increased anxiety, and has an anticonvulsant effect.
Plasmapheresis is a plasma replacement procedure. Used to detoxify the body after taking antipsychotics. Drug therapy is stopped for this period.
Electroconvulsive therapy or electroshock treatment. A painless procedure (anesthesia is used), which is carried out in comfortable conditions. Despite its terrifying reputation, it gives surprisingly good results for affective disorders, which include PSD.

Psychotherapy

Group therapy. Includes cognitive and behavioral psychotherapy. Helps a patient with PSD understand the relationship between his disease and problems that arise in communication. A person stops feeling lonely when he understands that everyone has difficulties, and they can be solved.
Family. Many psychoneurological dispensaries offer courses (trainings) to train relatives of patients. Here they are taught correct behavior and given full information about his illness.
Individual. The psychotherapist, using the arguments of logic, consistently forms the patient’s understanding of his condition, helps to rebuild his value system and views on the world around him.

Leaving this mental disorder untreated means not only dooming the patient to suffer from symptoms of depression, but also greatly increasing the risk of suicide. Take care of your loved ones, and the disease will recede before your persistence, because as E. Remarque wrote:

«… and it’s good that people still have many important little things that chain them to life and protect them from it. But loneliness—real loneliness, without any illusions—comes before madness or suicide.”

The main symptoms of schizophrenia are considered to be apathy, lack of will, withdrawal, strange behavior associated with experienced hallucinations, delusional ideas. However, these symptoms may accompany other mental conditions, which are important to correctly differentiate for successful treatment.

Symptoms of schizophrenia - danger in diagnosis

Unfortunately, only experienced and highly qualified doctors can carry out a full diagnosis. This requires not only academic knowledge, but also extensive practical experience. Symptoms of schizophrenia are often confused with symptoms of organic brain diseases, toxic and infectious lesions of the nervous system.

Unfortunately, specialists at the Preobrazhenie Clinic often encounter diagnostic errors. Treatment is often carried out in the wrong direction, so the main symptoms of schizophrenia not only do not go away, but often begin to increase, and the person’s condition worsens.

Schizophrenia as a disease was discovered only two centuries ago. It was then that doctors began to describe the main symptoms of schizophrenia and select treatment methods.

And previously it was considered a vice, the possession of demons, and other supernatural explanations were also found.

The symptoms of schizophrenia, with a detailed picture of the disease, are noticeable even to an inexperienced person in medicine.

The main symptoms of schizophrenia are manifestations

Schizophrenia affects almost all areas of human mental activity:

The speech contains reasoning, delusional statements and slipping from an important topic to others. Thinking is unconnected, florid and viscous.
The will suffers greatly, and is painfully incapable of initiative, independent action and decision-making.
Emotions are inadequate to the events taking place, facial expressions and pantomime are almost completely absent, the voice is monotonous and devoid of emotional nuances.
A person loses social skills, communication is reduced to nothing, there is no desire to work, start a family and bring any benefit.

Types and types of symptoms of schizophrenia

continuous-progradient - the disease flows continuously with a gradually increasing personality defect;
paroxysmal-progradient - an exacerbation of the disease replaces a period of clinical remission, the destruction of personality increases with the progression of the disease;
recurrent – attacks of schizophrenia are replaced by states of stable rest, personality changes are insignificantly expressed; A favorable type of disease course in which a person maintains working capacity and social interests for a long time.

Productive and negative core symptoms of schizophrenia

Productive symptoms in schizophrenia include delusions, false perceptions, and strange behavior. Delusional thoughts are most often associated with feelings of special destiny, persecution, jealousy, or fantastic cosmogonies. Pseudohallucinations are usually of a verbal nature, commenting on or criticizing the patient’s actions. Other deceptions of perception can be in the form of oneiric visual hallucinations (cosmic dreams), changes in taste, crawling of non-existent insects or worms and a distorted perception of one's body.

Negative symptoms are expressed as apato-abulic syndrome, i.e. a decrease in the emotional-volitional manifestation of a person. Sooner or later, this leads to a personality defect in schizophrenia - such changes in the patient’s psyche that make it impossible for a person to fulfill his family and social functions. Patients with schizophrenia with a severe personality defect are incapable of productive activity. They give up studying, cannot hold down a job, stop caring about their loved ones and taking care of their appearance.

Depressive symptoms of schizophrenia

Depression and mania in patients with schizophrenia are quite common and they have their own characteristics. Affective disorders in schizophrenia occur in a quarter of cases of the disease.

Mania in schizophrenia manifests itself through foolish behavior, elements of anger and frenzy. Unlike affective disorders, a manic state in schizophrenia develops suddenly and disappears just as quickly.

Depressive symptoms of schizophrenia have endogenous features

seasonality of occurrence - deterioration of the condition in the off-season: spring and autumn;
mood swings occur without external causes - there are no visible traumatic situations;
changes in mood during the day - in the morning the background mood is much worse than in the evening;
overvalued ideas or delusions of attitude;
pronounced vital coloring of statements - a strong feeling of melancholy, pronounced depression, pessimism and despondency;
psychomotor retardation - the patient does not ask for anything, does not strive for anything, sits for a long time in a drooping position.

Schizophrenic depression is usually accompanied by excessive anxiety and internal tension, without mental or physical justification. Anxiety-depressive syndrome in schizophrenia, in the absence of help from a psychiatrist, can lead to suicide. Relapse of depression often leads to new psychosis, so depressive symptoms in schizophrenia are grounds for hospitalization of the patient. Mood disturbances in schizophrenia are always combined with the main symptoms of schizophrenia.

Schizophrenia attack symptoms

During an exacerbation of schizophrenia, the first thing that catches your eye is unreasonable anxiety. This may manifest itself as even stronger withdrawal or psychomotor agitation. The patient experiences severe mental stress, often hears voices of a threatening nature, becomes uncritical of his delusional thoughts and expresses them out loud.

During this period, a person stops sleeping at night, there is practically no appetite, anxiety and irritability increase. He also makes attempts to protect himself from danger by performing ridiculous actions or rituals, becomes distrustful of loved ones, and may begin to become an alcoholic or run away from home.

During psychosis, it is important to calm the person as much as possible, agree with his ideas and call a psychiatric ambulance team or a private psychiatrist.

Aggression as symptoms of schizophrenia

Relapse of schizophrenia may be accompanied by aggressive behavior. The patient is excited, rushes around the apartment, the mood changes sharply from supportive goodwill to violence and frenzy, and back. There is no criticism of one’s condition. Patients cease to realize where they are, get confused in time, and do not understand what is happening around them.

During attacks of aggression, patients can harm both themselves and others. You need to contact a psychiatrist as soon as possible to provide emergency psychiatric care.

Diagnostic symptoms of schizophrenia

The diagnosis of schizophrenia can only be made after long-term observation by doctors in a psychiatric hospital. A group of psychiatrists and other specialists collect the necessary life history, ask the patient and his immediate family about the onset and course of the disease, and conduct all the necessary examinations.

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We do not believe in miracles and easy #results of #treatment for #mental #illnesses. We are fighting together for your healthy life. The desire and willpower of a person, as well as the help of people close to him, are very important.

Depression and schizophrenia may have similar symptoms - depressed mood, feelings of guilt, a person’s “obsession” with inadequate ideas (that he is seriously ill or has not succeeded in any way in life). In both cases, a person may not get out of bed for days or weeks, abandon usual activities, stop communicating with loved ones, and even try to commit suicide.

Only a psychotherapist can distinguish between depression and schizophrenia. It is possible that a person suffers from both (depressive schizophrenia), so you should not postpone a visit to a specialist.

Depression can also occur after schizophrenia - due to exhaustion of the body and side effects of therapy. For post-schizophrenic depression (depression after schizophrenia), the attending physician must adjust the therapy - change the combination of medications, select adequate dosages. You should not self-medicate and put off seeing a doctor, because in this condition a person has a high risk of suicide.

Depression in schizophrenia

One in four people with schizophrenia experiences depression. Manifestations of depression dominate, while signs of mental illness are present slightly, more often with negative symptoms (lack of will, emotional coldness) than with positive ones (delusions, hallucinations).

Depression in schizophrenia is confirmed by symptoms that manifest themselves as follows:

psychomotor retardation - a person does not get out of the inhibited state, is constantly in indifference (apathy) and does not want to do anything;
gloom, melancholy, indifference to everything around - a person has no reaction to what is happening, he perceives both joyful and sad events with equal indifference.
sleep disturbance and anxiety.

Can depression turn into schizophrenia?

It happens that prolonged depression gradually turns into schizophrenia. An experienced specialist will see signs of schizophrenia at the beginning - symptoms unusual for depression, changes in tests, insufficient effect of medications.

Special methods help diagnose the problem in a timely manner:

Clinical and anamnestic examination- the psychiatrist questions the person and identifies symptoms (overt and hidden).
Pathopsychological study- a clinical psychologist identifies specific thinking disorders in a person.
Modern laboratory and instrumental methods(Neurotest, Neurophysiological test system) - allow you to accurately, objectively confirm the diagnosis of “schizophrenia” and assess the severity of the disorder.

Clinical and anamnestic examination in psychiatry is considered the main diagnostic method. The psychiatrist talks with the patient, notes the characteristics of the mental state, observes facial expressions, reactions to questions, intonation, and notices what is not visible to a non-specialist. If necessary, the doctor prescribes additional tests.

How to distinguish depression from schizophrenia? Only a doctor can answer correctly.

Treatment depends on the severity of symptoms. Drug correction of symptoms is carried out:

neuroleptics;
antidepressants;
tranquilizers;
sedatives.

After the symptoms subside, the patient can begin psychotherapy, which is carried out by a professional psychotherapist. A person, with the help of a specialist, determines what led to the disease - stress, conflicts with loved ones, internal experiences. This way he can figure out at least part of the causes of the disease and increase the chances of a stable and long-term remission.

Types of schizophrenia are determined by the nature of symptoms and characteristics of the course. Manic schizophrenia is characterized by a number of specific manifestations - periods of severe depression are followed by periods of increased excitability and mania. The disease cannot be cured completely, but drug therapy in many cases allows one to achieve long-term remission and live in society. At the same time, for schizophrenia, medications will have to be taken on an ongoing basis, otherwise the disease will worsen, accompanied by severe symptoms.

The disease can occur in people of any gender

Schizophrenia is a severe mental disorder that changes the perception of reality. Despite the fact that the disease was first described more than a hundred years ago, doctors still cannot accurately determine the mechanisms of its development.

The disease can take many forms, and manic schizophrenia is one of them. Moreover, doctors are still not sure whether this is directly related to the negative symptoms of schizophrenia, or whether the manic-depressive phases are a secondary mental disorder against the background of this disease.

Today, schizophrenia is very common and is diagnosed in four out of a thousand people. This disease is one of the three diseases leading to early disability.

The problem with schizophrenia is the difficulty of treatment. There is no universal drug for this disease, so patients have to find the optimal medicine for a long time. Some drugs cause severe side effects, while others with less dangerous side effects may simply not be suitable for the patient.

The disease is equally common in women and men. At the same time, the symptoms cannot be accurately divided into purely feminine and purely masculine. As a rule, in women the disease first manifests itself at a later age, and the course of the disease is more favorable. In other words, by taking the right medications, it is possible to achieve a stable remission, in which the symptoms of the disease completely subside and do not affect the person’s quality of life. Despite the fact that in some patients, after treatment, the disease may not reappear at all throughout life (subject to constant supportive drug therapy), there is always a risk of exacerbation due to any traumatic factors.

Manic-depressive schizophrenia refers to a disorder of consciousness that occurs under the guise of manic-depressive psychosis. However, it is impossible to establish for sure whether psychosis is a consequence of schizophrenia or its main symptom.

This type of disease is characterized by obvious affective disorders. The condition is often mistaken for bipolar disorder, which can make diagnosis difficult. In general, the diseases are very similar, however, with bipolar disorder against the background of schizophrenia, pronounced positive and negative symptoms of the underlying mental illness are observed.

There is no diagnosis of manic schizophrenia in ICD-10. This disease is designated by two codes at once - F20 (schizophrenia) and F31 (bipolar affective disorder).

What is manic-depressive psychosis?

In the modern world, pathology has become diagnosed much more often than before.

Manic-depressive psychosis is an independent disease, an outdated name for bipolar affective disorder. The word “bipolar” means that symptoms appear in phases, changing to the opposite. In other words, the patient begins a phase of severe depression, which after some time is replaced by an acute manic phase.

Bipolar affective disorder should not be confused with manic-depressive schizophrenia. These are different mental illnesses that can develop in parallel. In general, there is no official diagnosis of manic schizophrenia. Usually we are talking about schizophrenia aggravated by bipolar disorder. Moreover, we can talk specifically about manic schizophrenia only if the patient first developed symptoms of schizophrenia, which were eventually joined by manic-depressive disorder.

Schizophrenia with manic symptoms is very similar to bipolar disorder in its symptoms, but differs in treatment methods. The patient's response to medications used for bipolar disorder is the main difference between manic schizophrenia and psychosis.

Depressive phase in schizophrenia

As already mentioned, manic schizophrenia, the symptoms of which resemble bipolar affective disorder, occurs in alternating phases.

The initial phase of this disease is most often depression. It develops rapidly, symptoms increase literally within a few days, progressing from a mild form of depressive disorder to severe depression.

During the depressive phase of manic schizophrenia, the symptoms are the same in men and women.

With this disease, all the signs of the so-called “depressive triad” are observed:

slowing down of speech and speed of thinking;
motor retardation;
flattened affect.

The patient shows low interest in surrounding events, demonstrates complete apathy and lack of interest. The term “flattened affect” refers to the weakness of emotional reactions, inhibited and feigned expression of emotions.

The patient's speech becomes lifeless and loses its emotional coloring. Patients tend to speak monotonously, try to answer in monosyllables, or completely ignore questions.

Motor retardation is manifested by a slowdown in the speed of reaction to stimuli, poor facial expressions and a slowdown in all movements in general.

The depressive phase is accompanied by the following symptoms:

loss of appetite;
tendency to self-examination;
hypochondria;
yearning;
prolonged immobility, stupor;
asthenia;
thoughts about suicide.

This phase lasts a long time and negatively affects the general psycho-emotional state of the patient. Often, a patient with schizophrenia has obsessive thoughts that amount to suicide attempts.

Signs of a manic phase

A sharp change in mood, from one to another, is a typical symptomatic picture

The second phase, manic, is the opposite of the depressive state and is manifested by the patient’s general agitation. Typical symptoms:

emotional agitation;
active facial expressions and gestures;
fast speech with expressive coloring;
feeling of spiritual uplift;
elevated mood.

The manic phase against the background of schizophrenia is often manifested by a jump in ideas. This is a disorder in which thinking speeds up significantly, causing the person to jump abruptly from one idea to another. In manic schizophrenia, this is manifested by rapid speech with unfinished sentences. A person jumps from one topic to another. The jump of ideas is based on associative chains that may be incomprehensible to others if schizophrenia is aggravated by delusions. Quite often these associations are inconsistent, speech is greatly accelerated, but with due attention it becomes noticeable that a person’s thinking is coherent, it is simply not ordered.

Often, manic syndrome due to schizophrenia is manifested by illogical actions of the patient. The patient may wave his arms, speak very quickly, jumping from one thought to another, run and show impatience in other ways. This is due to general emotional arousal and an increase in the speed of mental processes in the central nervous system.

Other shapes and features

Signs of manic schizophrenia can be aggravated by hypochondria, delusions and hallucinations. At the same time, hypochondria and obsessions are more pronounced in the depressive phase, and delusions and hallucinations are more pronounced in the manic phase. In general, the specificity of symptoms depends on the severity of schizophrenia and additional factors.

There are some differences between the symptoms of manic schizophrenia in men and women. As a rule, in women the depressive phase occurs in a more severe form. In men, the manic phase is more pronounced, but the depressive state can be smoothed out. This is largely explained by the specifics of mental processes in men and women.

Course of psychosis

In case of illness, the state of depression can last up to six months

The phases replace one another, but there may be differences in the course of the disease in different people. As a rule, the depressive phase is more pronounced and can last up to several years. However, in most cases its duration is 4-6 months. The depressive phase is replaced by a manic phase, the duration of which is usually shorter, no more than 1-2 months. However, in men, the manic phase can be more pronounced and last longer.

Between phases there may be some period of normalization of the mental state, but in the case of schizophrenia with manic syndrome it is expressed very little. In general, the disease can occur in the following forms:

unipolar form - there is only one phase, often manic, which is replaced by a short period of mental stability, and then repeats again;
bipolar sequential form - sequential changes in depressive and manic states are typical, the clinical picture is characteristic of bipolar affective disorder;
bipolar inconsistent form - mania is replaced by a period of mental balance, and then mania occurs again, after which depression is possible, followed by a state of intermission;
circular form - there is no state of rest between phases, so one phase immediately flows into another.

In the case of schizophrenia with manic syndrome, a unipolar form or a circular form of affective disorder is more often observed. Moreover, the latter option is more difficult, since it is more difficult to correct with medication.

Diagnostics

The diagnosis of “schizophrenia with manic syndrome” is made only if the patient first experienced general symptoms of a schizophrenic disorder, against which bipolar affective disorders developed. Otherwise, a diagnosis of bipolar affective disorder will be made.

Here it is important to be able to distinguish the sequential change of phases from seasonal affective fluctuations characteristic of patients with schizophrenia. In general, the diagnosis is made based on medical history, conversation with the patient, and testing. In some cases, several months of observation are necessary to identify a specific form of schizophrenia.

Treatment principle

For each specific case, treatment is selected individually by a specialist.

The basis of treatment for the disease is drugs from the group of antipsychotics. They effectively relieve both the symptoms of schizophrenia and the manifestations of manic syndrome. However, in the depressive phase, these drugs are ineffective and can only worsen the patient’s well-being, so complex therapy and correct dosage selection are necessary.

There is no universal drug that would suit all patients, so the treatment regimen is selected in several stages. All this time the patient must be under the supervision of a doctor. As a rule, they end up taking antipsychotics in the manic phase and tricyclic antidepressants in the depressive phase.

In the vast majority of cases, atypical antipsychotics are effective, but in some patients, taking these drugs can cause an exacerbation of the disease.

The goal of drug treatment is to achieve stable remission, when the duration of the phases of mania and depression is reduced, and over time, such symptoms completely disappear. After the depressive state has been relieved, they switch to constant use of medications for schizophrenia. In this case, the patient should be regularly examined for timely detection of negative dynamics of treatment or the development of side effects.

Forecast

No doctor can accurately predict the further course of the disease. Some patients manage to achieve stable remission. In such cases, only a single manifestation of the disease is possible throughout life, without further relapses. After a long course of taking medications, a decision may be made to prescribe a small maintenance dose, which will reduce the risk of recurrence of the disease without side effects.

In some cases, drug therapy can only achieve a reduction in the duration of one or another phase.

Patients are advised to regularly visit their doctor in order to be able to promptly recognize an exacerbation of the disease. As a rule, supportive drug therapy is complemented by psychotherapy to improve the patient's socialization.