Schizophrenic psychosis is an acute mental disorder that combines symptoms of schizophrenia and psychosis. In the clinical picture of this condition, affective behavior and manic psychopathy are closely intertwined with the characteristic schizoid symptoms characteristic of this disease.

How to distinguish schizophrenia from similar mental pathologies? A feature of schizophrenic thinking disorder is the fact that it occurs against the background of maintaining a person’s intellectual abilities. This destruction of worldview can develop either slowly or quickly, usually accompanied by an increasing loss of energy, symptoms of autism.

The term “schizophrenia” comes from the ancient Greek words with the roots “schizo” (trans. - “to split, split”) and “phren” (“soul, thought, mind, thinking”). Thus, the name of the disease can be roughly translated as “split, split consciousness, thinking.”

Schizophrenia is classified as a group of mental illnesses, the causes of which lie within the human body and are not associated with any external influences on it.

The nature of schizoid disorders makes them fundamentally different from other mental illnesses. A schizophrenic will not become mentally retarded. His level of intelligence will remain the same, although irreversible changes of a pathological nature in the psyche, of course, occur. Sometimes the triggering factor for the development of “special” thinking and worldview in a schizophrenic, as in a number of other psychopathies, will also be stress, heredity, and somatic illnesses.

There is an opinion that the causes of schizoid personality disorder and genius are essentially the same. There are a large number of very gifted and talented people with characteristic symptoms of a schizophrenic nature (even if they did not receive an established diagnosis during their lifetime).

The works of M. Bulgakov, F. Kafka, Guy de Maupassant, F. Dostoevsky, N. Gogol are still read by millions of people around the world today. Canvases by the brilliant artists Vincent Van Gogh and M. Vrubel cost a lot of money. The philosophical works of Nietzsche and Jean-Jacques Rousseau had a significant influence on the development of thought of humanity as a whole. But all these people, one way or another, showed signs of mental disorders. The famous scientists A. Einstein and I. Newton also had a schizoid personality type.

It is obvious that with this pathology both the memory and intelligence of the individual are preserved. The individual continues to hear, see, smell and touch normally, and the brain perceives all incoming information about the world. But processing all this data fails. As a result, the picture of the world compiled in the mind of the patient is radically different from the perception of ordinary healthy people.

Schizophrenic psychosis is an acute stage of manifestation of schizophrenia. Quite often, gradual changes in a person’s psyche are practically invisible to others until these disorders acquire the character of psychosis. The clinical picture of this phase is quite vivid, and often its symptoms become the reason for a diagnosis of schizophrenia.

Symptoms of schizoid mental confusion

At the initial stage of development of the disease, a person gradually becomes more and more absent-minded, often stops performing ordinary household rituals, because he does not see the point in them. For example, he stops washing his hair or brushing his teeth - all this will inevitably get dirty again. His speech becomes monosyllabic and slow. Emotions and feelings seem to fade away, the patient almost does not look people in the eyes, his face does not express anything, he loses the ability to enjoy life.

1. Symptoms of autism. The mentally ill person is completely immersed in his inner world, not reacting to the life around him, ceasing to interact with others. The difference between his usual activity and the ensuing indifference becomes obvious.
2. Inappropriate reactions of an affective nature. It is common for a normal person to laugh and rejoice during cheerful and happy events, and to be sad during grief and failure. A schizophrenic may well react with laughter to threatening events, sincerely rejoice at the sight of death, etc.
3. Destroyed associative logic (alogy). Usually it is expressed in the fact that a person loses logical thinking. It is in this regard that the answers of patients with schizophrenia in dialogue are usually monosyllabic - they do not think about the subject of the conversation, without logically developing it in their thoughts, as an ordinary healthy person does.
4. Simultaneous experience of opposing feelings and emotions. Literally, such people can love and hate at the same time - those around them, events, phenomena. The patient's will may be paralyzed, since he is unable to make a specific decision, endlessly oscillating between essentially opposite possibilities.

Of course, the entire set of symptoms of the disease is much wider, and its specific varieties differ from each other in a number of specific signs. Therefore, it is important for a psychiatrist to collect a complete history to make a correct diagnosis.

Differences between schizophrenia and other mental disorders

It is necessary to understand the difference between diseases with similar symptoms and schizophrenia. The diagnosis of “schizophrenia” presupposes its own characteristics and is not made immediately by psychiatry; it is necessary to monitor the patient for a certain period of the disease, including periodic exacerbations.

The main difference between psychogenics is the patient’s aggressive behavior, which is provoked by a certain situation. Modern medicine distinguishes a large number of types of psychogenia, classifying them both by the causes of occurrence and by characteristic symptoms - reactive, acute, delusional psychoses, etc. etc.

Although the study of the spectrum of psychoses demonstrates that the clinical picture of different types will always have some similar features. Sharp mood swings, a jump from megalomania to self-deprecation, from euphoric flight to deep depression, occur in both psychogenics and schizophrenia.

Without all the symptoms of schizophrenia, but, nevertheless, similar to it - schizophrenia-like - can be provoked, for example, by alcohol, drugs, age-related disorders of the brain, and infectious diseases. There are cases where schizophrenia-like psychosis by all indications developed as a consequence of epilepsy and hypertension.

A person suffering from mental destruction of the schizoid type may also find himself in a stressful situation (serious experiences are the cause of a large number of psychogenic destruction of a person’s consciousness), which will expand the symptoms of the clinical picture.

In any case, in order to accurately establish the true nature of a mental disorder, psychiatrists need to carefully monitor the dynamics of the development of the pathology.

Acute phase symptoms

A severe schizophrenic attack manifests itself as psychosis. This disease is characterized by a change in acute phases and periods of remission, where each subsequent attack caused by an outbreak of the disease will be more severe than the previous one. The severity of symptoms also increases, and periods of remission may become shorter over time.

Schizophrenic psychosis most often manifests itself acutely in the patient, with a number of characteristic signs and symptoms, including:

• hallucinations (visual, auditory, olfactory);
• rave;
• persecution mania;
• depressive detachment, sudden mood swings, violent manifestations of emotions (affects);
• complete separation from reality up to depersonalization (a person imagines himself as an animal, an object, etc.);
• excessive motor activity or stupor;
• thinking disorder, loss of ability to think coherently;
• lack of understanding of the abnormality of one’s condition, complete immersion in an illusory pseudo-reality;
• autism (withdrawal into one’s own world, cessation of contact with the surrounding reality).

These, of course, are just some of the features by which schizophrenic psychosis is recognized. You can learn how symptoms in schizophrenia progress, bringing the patient to the acute stage of the disease, from the following video:

Causes

Medicine still raises many questions about both the causes and the mechanism that turns a schizophrenic attack into psychosis. Science periodically encounters new facts and hypotheses about the etiology of schizoid mental disorder. Currently, the list of main causes of the disease includes:

1. Genetic predisposition.
2. Prenatal factors. For example, infections in the mother during pregnancy increase the risk of mental disorders in the child.
3. Social factors. Discrimination, moral trauma received by a child in the family, social loneliness, as well as other psychotraumatic situations.
4. Drugs and alcohol abuse. There is an obvious connection between the destruction of the psyche in people who took, for example, narcotic synthetic salts, smoked marijuana or spice, precisely with the fact of drug addiction. Even mild psychoactive substances can cause the onset of schizophrenia in some people.
5. Brain dysfunctions associated with various causes (neurochemical hypotheses).

Psychiatry continues to recognize that the causes that cause the acute form of the disease, schizophrenic psychosis, are currently not well understood and require further scientific research.

Treatment of schizophrenic psychosis

Schizophrenia itself can be successfully treated on an outpatient basis - the patient needs to take medications regularly and periodically visit the attending psychiatrist. But schizophrenic psychosis requires mandatory hospitalization, since the stage of the disease requires inpatient observation and treatment.

In cases where the attack is provoked by drugs or alcohol, before starting the examination it is necessary to carry out mandatory detoxification of the patient’s body.

The main therapy for psychosis will be divided into three stages:

1. Removal of the acute psychotic phase (therapeutic measures are carried out until the permanent disappearance of pathological symptoms - delusions, hallucinations, affective behavior).
2. Stabilization of the patient's mental state.
3. Maintenance therapy for the longest period of remission without relapse.

It is absolutely unacceptable to try to cope with psychopathy by self-medication. It is important for loved ones to clearly understand that a mentally ill person cannot decide to see a doctor on his own. Moreover, he poses a danger to himself and to others.

Conclusion

Contrary to popular belief, schizophrenia is not a death sentence. Experienced psychiatrists with extensive work experience openly admit that in human society many people with such a diagnosis are not locked in the wards of psychiatric clinics, but live normally, work successfully and lead a completely ordinary lifestyle.

To ensure that the symptoms of the disease do not bother the patient for a long time, he must strictly follow the doctor’s recommendations, undergo examinations on time and go to the hospital if circumstances require it. Often this requires the support of relatives, since the patient himself does not always realize that he is sick and needs help.

If all these conditions are met, then the risk of developing schizophrenic psychosis is reduced to almost zero, and the patient can remain in remission for a long time, without suffering from exacerbations and symptoms of his disease.

Differences of opinion and related difficulties among experts arise when it is necessary to recognize the prodromal period of the disease, as well as its subacute onset. Especially, the difference between pschosis and psychosis can be difficult in the case of a sluggish process, with deep remissions, as well as in cases where there is a combination of schizophrenia and alcoholism. It is difficult to distinguish psychosis from schizophrenia if the patient has suffered mental trauma, when the clinical picture has psychogenic inclusions. In addition, it is sometimes not easy to draw the line between the initial symptoms of schizophrenia and psychopathy and neurotic conditions.

In order to understand the situation in detail, it is necessary to study the clinical picture in detail, to identify what the characteristic features of the patient are. In particular, you need to pay attention to external events that preceded the disease. All these measures contribute to correct diagnosis. If there is a neurotic state, then the most noticeable signs in this case are considered to be signs of weakness, asthenia, and irritability. As you know, in patients with psychosis, emotions are more vivid, lively, they are always influenced by circumstances. As for schizophrenia, already in the initial period it is possible to note a particular inadequacy in terms of emotions. The patient develops thinking disorders, they are expressed in the form of a certain cessation of thoughts, peculiar influxes, in some cases there are manifestations of autism at the initial stage.

Doctors believe that the emotional reaction of patients suffering from schizophrenia is excessively rigid, and the real situation that caused them begins to dominate the patient’s mind without reason, and the patient develops a painful interpretation of the situation. In some cases, identifying the difference between schizophrenia and psychosis becomes possible due to the nature of the action, which is socially dangerous. At this stage of the disease, such a condition may be alien; it occurs unexpectedly for the patient himself.

Differential diagnosis

Differential diagnosis of psychopathy and schizophrenia has its own characteristics, for example, changes in personal characteristics, the occurrence of indifference, apathy, and thinking disorders are important. According to follow-up observations, with untimely recognition of schizophrenia, which was initially diagnosed as psychosis, there is a slow development of mental changes typical of schizophrenia. In Israel, the distinction between schizophrenia and psychosis is carried out by experienced specialists; they are familiar with the diagnostic difficulties that arise in the case of remission, accompanied by psychopathic behavior of patients.

In such cases, the true nature of mental changes can be discovered only through careful research, when an in-depth study of the dynamics of a given mental state is carried out. In addition, a number of signs are important for diagnosis along with data on the disease. For example, rudiments of delusional ideas, pretentious poses, catatonic-hebephrenic microsymptoms, elements of so-called crooked thinking, slight foolishness, and so on. Significant difficulties may arise if it is necessary to distinguish schizophrenia, accompanied by systematized delusions, from such a condition as the gradual development of psychopathic personalities.

According to doctors, the stage of development of clinical symptoms is characterized by fewer difficulties associated with differential diagnosis. In such situations, schizophrenia must be distinguished from possible schizophrenia, which have schizophrenia-like symptoms. In particular, this refers to traumatic psychoses, rheumatic psychoses, cerebral syphilis, etc. It is also necessary to distinguish schizophrenia from presenile and circular psychosis. It is known that if symptomatic psychosis is caused by an organic lesion, then such disorders as reduced intelligence, memory impairment, exhaustion, and other signs make themselves felt.

Features of the difference between psychosis and schizophrenia

It is very important to distinguish schizophrenia from a mental illness such as. It is with them that specialists have to deal when it comes to forensic psychiatric practice. In addition, it often happens that the nature of a disease state can only be determined if the dynamics of mental disorders are taken into account. Often, in the presence of a psychotraumatic situation, the clinical picture of schizophrenia can be modified. As for psychogenic factors, they are diverse; the distinction between psychosis and schizophrenia in Israel is always carried out taking into account the symptoms and form of the process.

Patients often experience delusional and hallucinatory experiences that are situationally motivated. In particular, this applies to patients with paranoid psychosis. In this case, the clinical picture is represented by a depressive affect, which may give the impression that the person is reacting adequately to the situation. Therefore, a masking effect occurs, which makes it difficult to distinguish psychosis from such a complex disease as

SCHIZOPHRENIA AND DELUSIONAL PSYCHOSES

Definition, main diagnostic criteria

Schizophrenia- a chronic mental endogenous progressive disease that usually occurs at a young age. Productive symptoms in schizophrenia is very diverse, but the common property of all symptoms is internal inconsistency, a violation of the unity of mental processes (schisis). Negative symptoms is expressed in a clear disturbance of thinking and progressive personality changes with increasing isolation, loss of interests and motivations, and emotional impoverishment. In the outcome of the disease, with an unfavorable course, a deep apathetic-abulic defect (“schizophrenic dementia”) is formed.

Schizophrenia is quite common disease- in most countries the number of patients is about 1% of the population. Every year, from 0.5 to 1.5 new cases per 1000 population are detected, the highest incidence rates occur in the age group from 20 to 29 years old.

Women and men get sick at approximately the same frequency, however early malignant variants diseases are observed predominantly in men, A acute affective-delusional attacks- in women.

Patients with schizophrenia account for about 60 % patients in Russian hospitals and about 20% of people under observation in the IPA.

Causes and mechanisms of development This disease has not been precisely elucidated. However, it has been shown that the most important role is played by hereditary factors(the share of heredity among all determining factors is about 74%), although the importance of environmental (family, social) factors is also important. The role of acute traumatic situations is usually considered insignificant.

The variety of clinical manifestations of schizophrenia led to the fact that until the end of the 19th century. patients with this disease were included in a variety of diagnostic groups. The idea about the common nature of all these disorders belongs to a German psychiatrist E. Kraepelin who named this disease "dementia praecox" (dementia praecox). Having studied the medical histories of many patients, he noticed that all of them developed normally in childhood, but in adolescence or young adulthood a variety of disorders arose (delusions, hallucinations, emotional and motor disturbances), which progressed rapidly and led to the loss of many social skills (dementia ). In general, Kraepelin’s ideas were highly appreciated in most countries, but many researchers drew attention to the fact that not all variants of the disease are malignant, and the name “dementia praecox” is therefore unfortunate.

The patient is married and has good qualifications

Active cooperation with a doctor, independent administration of maintenance medications.

Course and prognosis

The course of schizophrenia is usually defined as chronic, progressive. However, there are both malignant variants of the disease, which begin at an early age and lead to permanent disability within 2-3 years, as well as relatively benign forms with long periods of remission and mild personality changes. Approximately 30% of patients retain their ability to work and high social status throughout their lives. Maintenance treatment with antipsychotics is thought to increase the likelihood of a favorable outcome. To maintain the patient’s social status, family support and the right chosen profession are of great importance.

Continuous type flow is characterized absence of remissions. Despite changes in the patient's condition, psychotic symptoms never completely disappear . The most malignant forms are accompanied by early onset and rapid development of apathetic-abulic syndrome(hebephrenic, catatonic, simple). At late start disease and the predominance of delusions (paranoid schizophrenia), the prognosis is more favorable, patients remain in society longer, although complete reduction of symptoms cannot be achieved either. Patients with the mildest forms schizophrenia (senestopathic-hypochondriacal form) can remain able to work for a long time.

Paroxysmal-progressive (fur-like) type currents are different presence of remissions. Delusional symptoms occur acute, the manifestation of delirium is preceded by persistent insomnia, anxiety, and fear of going crazy.

Rave in most cases unsystematized, sensual, accompanied by severe confusion, anxiety, agitation, sometimes combined with mania or depression. Among plots of delirium prevail ideas of relationship, special meaning, delusions of staging often arise.

Acute attack of schizophrenia continues several months (up to 6-8 months) and ends with the disappearance of delusional symptoms, sometimes with the appearance of criticism of the psychosis suffered. However, from attack to attack there is a stepwise increase in the personality defect, leading to disability. In the final stages of the disease, the quality of remissions progressively worsens and the course approaches continuous.

Periodic (recurrent) type currents - the most favorable option course of the disease, in which long clear intervals without productive symptoms and minimal personality changes can be observed ( intermission).

Seizures occur Affective disorders (mania or depression) are most acute and pronounced; at the height of the attack, confusion of consciousness (oneiric catatonia) can be observed.

Personality defect even over a long period of time it does not reach the level of emotional dullness. Some patients experience only 1 or 2 attacks throughout their lives. The predominance of affective disorders and the absence of gross personality defects make this variant of the disease the least similar to typical forms of schizophrenia.

ICD-10 proposes to include acute short-term psychoses (lasting less than 1 month)not to schizophrenia, but to acute transient or schizoaffective psychoses.

Diagnosis sluggish (low progression) schizophrenia quite often used by Russian psychiatrists. From the point of view of medical theory, it seems quite logical, since almost all known mental and physical diseases have both severe and milder variants. E. Bleuler also pointed out the possibility of mild (latent) forms of schizophrenia. Unfortunately, in the 70-80s of the XX century. the term became the subject of political debate. In addition, psychiatrists have recently tended to avoid diagnoses that are viewed with fear and may cause stigmatization (see section 3.7). In ICD-10, mild neurosis-like and psychopathic variants of the disease are classified as schizotypal disorders .

Other delusional psychoses

Delusions are not a disorder specific to schizophrenia and can occur in most mental illnesses.

Reactive paranoid - delusional psychosis caused by severe psychological trauma (for example, legal proceedings, conscription into the active army, travel to an unfamiliar country). Psychosis is closely related to a traumatic situation, can be quite short-lived, does not leave behind any personality changes, and does not recur throughout life.

Involutionary paranoid - psychosis of involutionary age (occurs after 45-50 years), manifested by delirium of everyday relationships (“delirium of small scope”). This disorder is different stability, usually does not progress, but also difficult to treat with neuroleptics . Patients claim that those around them cause them material harm (spoil and steal things), annoy them with noise and unpleasant odors, and try to get rid of them, hastening their death.

Rave lacks mystique, mystery, specific. Along with delusional experiences, there may be individual illusions and hallucinations (patients smell “gas”, hear insults directed at them in outside conversations, feel in their bodies signs of ill health caused by persecution). Even with long-term delirium There is no pronounced apathy and abulia, the patients are quite active, Sometimes arise anxiety and depression.

Before illness patients often differ narrow interests, conscientiousness, frugality, have relatively modest demands. They love independence in everything and therefore are often lonely in old age. Deafness and blindness also predispose to the disease. Women get sick more often.

Paranoia - chronic delusional psychosis, at which rave - the leading and, in fact, the only manifestation of the disease.

Unlike schizophrenia nonsense racks, is not subject to any pronounced dynamics, it always systematized and monothematic (paranoid syndrome).

Prevail plots of persecution, jealousy, hypochondriacal ideas, often Querulant tendencies(“delirium of complainers”).

Hallucinations are uncommon.

None pronounced personality changes and emotional-volitional impoverishment.

Begins disease in young and old age.

The persistence of delirium determines low efficiency existing methods therapy. Drug therapy is prescribed to reduce the tension of patients, it is especially necessary in the presence of aggressive tendencies, or when there is a threat of committing crimes. Most patients maintain their social status and ability to work for a long time.

Treatment and care

Main method treatment schizophrenia is currently the use of antipsychotics (neuroleptics). A wide range of drugs are aimed at a variety of manifestations of the disease: to relieve psychomotor agitation and confusion(aminazine, tizercin, clopixol, chlorprothixene, topral), to reduce delirium and catatonic disorders(haloperidol, trisedyl, triftazine, etaparazine, mazeptyl). It is believed that the main action of antipsychotics is aimed at suppressing productive symptoms, but in recent years several have been proposed atypical antipsychotics, which allow you to restrain the increase in negative symptoms, and possibly mitigate the manifestations of autism and passivity(azaleptin-leponex, rispolept, zyprexa, fluanxol). Constant use of these drugs allows patients to maintain a high social status longer. For long-term maintenance therapy, depot drugs are also used (moditene depot, haloperidol decanoate). Monotherapy is considered ideal, but experience shows that in the chronic course of the disease it is often necessary to prescribe several antipsychotics at the same time.

Shock therapy methods(ECT, insulin comatose therapy) have been used quite rarely in recent years, since they do not have clear advantages over drug treatment. They are mainly prescribed patients with acute attacks of the disease and severe affective symptoms. ECT is considered an effective treatment for febrile schizophrenia. With this atypical variant of the disease, hemosorption, plasmapheresis and laser therapy also have a good effect.

The success of treatment largely depends on the correct care for the sick. The tasks facing nursing staff depend on the severity of the disorder and the stage of the disease.

Basic measures for caring for patients with schizophrenia at different stages of the disease

Acute attack of illness, initiation of treatment with psychotropic drugs:

Supervision, prevention of socially dangerous actions, ensuring somatic well-being;

Formation of cooperation and mutual understanding with the patient;

Organizing regular medication intake;

Early detection and relief of side effects and complications of therapy.

Recovery from acute psychosis, formation of remission:

Restoration of working capacity and social rehabilitation;

Overcoming a careless attitude towards the disease, justifying the need for maintenance therapy.

Remission, stable condition:

Strict adherence to maintenance therapy;

Combating stigma and self-stigma.

Final condition, permanent defect:

Ensuring necessary hygiene;

Straightaway after the patient is admitted to the hospital should be organized sufficient supervision to prevent aggressive and suicidal behavior of the patient. In recent years, there has been virtually no need to use measures of physical restraint, since the timely administration of neuroleptics makes it possible to stop agitation. Patients in a state of catatonic stupor should provide feeding, you also have to make sure that the patients are lying comfortably and require them to change their position in order to avoid bedsores. Important note the presence of stool and urination in helpless patients, regularly measure body temperature, inspect injection sites to exclude abscesses. In the first days of treatment with antipsychotics high probability of severe neurological disorders in the form of muscle spasms and hyperkinesis, if they appear, you should immediately call a doctor and introduce correctors (akineton, diphenhydramine, seduxen). Also high probability of collapse, so you have to help the patient get out of bed and accompany him to the toilet. At this stage, we often have to deal with the patient’s refusal to take medications. It is necessary to ensure strict adherence to doctor's orders. If there is complete refusal to cooperate, injections are prescribed, but it is important to try to convince the patient to take the medications on his own. Here, a lot depends on a sincere desire to help the patient; it is important to show sympathy and attention to his requirements, to ensure a minimal risk of side effects that could frighten the patient. Even with formal consent to treatment, some patients show amazing ingenuity to avoid taking antipsychotics. Therefore, you should be careful when dispensing medications, monitor the patient's actions, perhaps examine the oral cavity after administration, and then praise the patient for his understanding and cooperation.

Formation of remission in schizophrenia it occurs gradually; the disappearance of delusions and hallucinations does not mean a complete restoration of health. For quite a long time, patients still experience lethargy and lethargy. Often after an acute attack of illness there are long-term episodes of depression. The appearance of criticism is often associated with difficult moral feelings about actions committed in a state of psychosis and one’s future. Here it is important to reassure the patient, explain to him that currently there are many effective means of treating mental illnesses, that regular use of medications allows you to prevent repeated attacks, continue to work in the same place, have a full-fledged family, maintain clarity of mind and high performance. It is important to timely begin to prepare the patient for return to society. You should demonstrate your trust in him by letting him go home for a short period of time. It is also necessary to offer to return to classes postponed during illness (look at the missed class topics in the textbook, familiarize yourself with new official documents, finish reading the book you started). If the patient complains about the difficulties that have arisen, it is necessary to explain to him that he should not strive to work at full capacity for now, since large doses of medications and residual effects of the disease interfere with him, but in the near future his previous abilities will probably return, so one should not despair.

In some cases, recovery manifests itself as unreasonable complacency and carelessness. The patient declares that he has now completely coped with the disease and no longer needs the help of doctors; it is enough to “control himself” from now on. This is a very dangerous position, since currently there is only one way that truly reduces the likelihood of an attack - taking medication. We have to convince the patient that continued treatment is necessary . It is important to convey to him that the doctor is ready to cooperate, that if side effects occur, you can select the appropriate drug, but you cannot completely abandon antipsychotics.

IN state of stable remission the patient should feel like a full-fledged member of society. The patient’s relatives must understand that they should not create any special living conditions for him and in no case should he be released from his usual household duties due to the illness he has suffered. Sometimes it is even better to be demanding and insist that the patient complete an order that he refuses. There is no need to protect the patient from unpleasant news, since patients with schizophrenia are not very emotional and can often tolerate, without worsening their condition, an environment that seems unacceptable to some healthy people. The only medical requirement remains regular maintenance doses of antipsychotics !!! .

Sick in a state of permanent defect need outside care. Left to their own devices, they cannot provide adequate nutrition, do not maintain personal hygiene, and can become victims of scammers. Patients who have no relatives should be placed in a special boarding school. However, even in a special institution it is important to try to involve patients in some kind of activity. It is not easy, and simple violence does not solve the problem. It is important not just to take the patient out for a walk, but to involve him in an activity that is interesting to him. Therefore, in such institutions it is necessary to have conditions for a wide variety of activities (agricultural work, cleaning, playrooms, various workshops, a club). For patients living in their own apartment, the role of a rehabilitation center can be played not only by the IPA, but also by a special club house.

Differential diagnosis

Schizophrenia has a wide range of clinical manifestations , and in some cases its diagnosis is very difficult. The main diagnostic criteria for the disease are the so-called typical for schizophrenia negative disorders or peculiar changes in the patient's personality : impoverishment and inadequacy of emotional manifestations, apathy, autism, disturbances in the harmony of thinking(mentism, shperrung, reasoning, fragmentation). Schizophrenia is also characterized by a certain set of productive symptoms : feeling of putting and taking away thoughts, echo of thoughts, feeling of openness of thoughts, delusions of influence, catatonia, hebephrenia etc.

Differential diagnostic assessment schizophrenia has to be carried out mainly in three directions:

· with organic diseases (trauma, intoxication, infections, atrophic processes, tumors);

· with affective psychoses (in particular, MDP);

· with functional psychogenic disorders (neuroses, psychopathy and reactive states).

Exogenous psychoses start at connection with certain harms(toxic, infectious and other factors). Personality defect that develops when organic diseases , differs significantly from schizophrenic. originality productive symptoms are also different: exogenous type of reaction predominates: delirium, hallucinosis, asthenic syndrome - all these disorders are not typical for schizophrenia.

At affective psychoses (for example, with MDP) personality changes are not developing even with a long course of the disease. Psychopathological manifestations are limited mainly to affective disorders.

When diagnosing persistent delusional disorders , acute and transient psychoses It should be taken into account that, unlike schizophrenia, these diseases not accompanied specific schizophrenic personality defect, the course of these diseases doesn't detect progression. In their clinical picture, with some exceptions, there are no signs characteristic of schizophrenia ( schizis, delusional ideas of influence, automatism, apathy).

Distinct connection all manifestations with previous psychotrauma, rapid reversal of psychosis following the resolution of a traumatic situation, testify in favor of reactive psychosis .

When delimiting schizoaffective psychoses for other disorders discussed in this block, one should focus on the presence in patients with schizoaffective pathology psychotic attacks, manifested simultaneously by pronounced emotional disorders And hallucinatory-delusional experiences, typical for schizophrenia ( pseudohallucinations, ideas of influence, ideational automatism).

Delimitation schizotypal disorders from schizophrenia and other psychotic disorders discussed here does not present any particular difficulties, since they not typical severe psychotic level disorders(delirium, catatonia, pseudohallucinations, etc.). Symptoms of schizotypal disorders more similar to psychopathological manifestations of neuroses and psychopathy.

In contrast to low-grade schizophrenia (schizotypal disorders) neuroses are non-progressive psychogenic diseases and arise due to long-term intrapersonal conflicts. A psychotraumatic situation in this case is a condition decompensation of personality traits originally characteristic of the patient, while in low-grade schizophrenia one can observe transformation, modification of the original personality traits And increase in character traits typical of schizophrenia(lack of initiative, monotony, autism, indifference, tendency to fruitless reasoning and separation from reality).

Unlike schizotypal disorders psychopathy are characterized stability, their manifestations develop in early childhood And are persistently preserved without significant changes throughout life.

In acute attack of schizophrenic psychosis First of all, the first manifestation of psychosis must be correctly assessed. A clinically acute attack can unfold as a second attack or as a subsequent manifestation of psychosis, after the patient has been in a state of complete remission for more or less a long time. Therapeutically, in both cases it is the same problem, although the therapeutic prognosis will not be similar if this applies to the second or third attack of the disease.

Spicy attack most typical for periodic and paroxysmal-progressive types of schizophrenia. The choice of antipsychotic depends on the clinical characteristics of the acute attack.

In cases where the patient is in state of psychomotor agitation, if he is tense, aggressive, hostile, etc., the primary task of the psychiatrist is to quickly calm the patient, make him safe for others as soon as possible, prevent possible suicide attempts, and then include him in the life of the department. For this purpose, neuroleptics with the so-called broad spectrum of action (Bieitband no Arnold or Basis-neuroleptika no Gross and Kaltenback) are most suitable. According to Arnold, an antipsychotic used to relieve agitation must have the following properties:

1) cause a strong inhibitory effect;

2) have a rapid effect no later than 30 minutes after administration of the drug;

3) be suitable for parenteral administration;

4) have a fairly long-lasting effect (10-12 hours);

5) do not cause serious side effects.

Current clinical practice, confirmed by our experience, shows that the most suitable drugs that meet the above requirements are chlorprothixene, chlorpromazine and levomepromazine. The dosage of these drugs is determined by the condition of the patient, who must be under strict supervision. We should not forget that basic neuroleptics, especially at the beginning of their use, cause a strong hypnotic effect, although this is not absolutely necessary, but, of course, does not cause harm. If it is not possible to stop severe agitation, it is recommended to combine drugs.

Gross and Kaltenback believe that the basis neuroleptics should be combined with diazepam (Seduxen) 20-30 mg intramuscularly or intravenously. The same authors, who have extensive experience in treatment with psychotropic drugs, claim that the most pronounced sedative effect is characteristic of the combination of clopentixol (Sordinol) intravenously and diazepam (Seduxen) intramuscularly. We also made sure that the addition of chlordiazepoxide or diazepam to a broad-spectrum antipsychotic significantly enhances its inhibitory effect and thus this antipsychotic more effectively suppresses psychomotor agitation.

In particularly severe cases excitement You can resort to a combination of antipsychotics with an inhibitory effect and hypnotics. Kielholz notes that intravenous administration of 50-200 mg of promazine also produces a rapid sedative effect. According to Arnold, adding 1-2 ampoules of promethazine (Phenergen) to chlorprothixene enhances its effect.

It should be emphasized that as the main antipsychotic Chlorprothixene is more suitable than chlorpromazine, not only because the former acts stronger and lasts longer, but also because it is less toxic, and most importantly, does not cause allergic reactions in operating personnel.

Putting the patient into a long sleep for the purpose of dock excitement, as some psychiatrists once suggested, is not considered the best remedy. The principle of modern treatment of schizophrenia is the rapid introduction of the patient to the life of the department, hospital and the use of other methods, mainly occupational and psychotherapy.

The initial inhibitory therapy should be continued until the patient is completely calm and becomes available for the second phase of antipsychotic treatment, now directed against the core of psychosis. This second phase, which continues until remission occurs, can be called antipsychotic (antischizophrenic). It differs from the third phase - the so-called maintenance therapy, which occupies its special place in the holistic complex of neuroleptic treatment of schizophrenia. We dwelled on this issue in detail in the introduction to psychopharmacology.

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Psychosis

Types and classification of the disease

Exogenous— the external source of the disease can be industrial poisons, infections (influenza, syphilis, typhoid, tuberculosis), drugs, and also severe stress. The main cause of development is alcohol, which, if abused, can cause alcohol psychosis.

Depressive psychosis lasts from 3 months to a year and is associated with brain pathology, depression begins unnoticed and slowly. The main signs of the disease: constantly depressed mood, physical and mental inhibition. This form of psychosis is characteristic of highly moral, good people. The patient thinks only about himself, blames himself, looks for “mistakes” and shortcomings. A person's thoughts are centered around his personality, his mistakes and his shortcomings. A person has no doubt that there has been and never will be anything good in his life; in such a state he can commit suicide. With depressive psychosis, the condition is worst in the morning, and in the evening it rises, this disease is the opposite of neurosis, in which, on the contrary, the mood worsens at night.

— Psychosis is translated from Greek as a mental disorder, the word itself consists of two other souls and a disorder of the state.

— ZNF804A is a genome associated with psychosis.

— According to statistics, people with psychosis are less likely to commit crimes than mentally healthy people.

Mood disorders can be depressive, while the patient practically does not eat, is lethargic, moves and communicates little, is pessimistic, is dissatisfied with everything, and sleeps poorly. In manic disorders, the symptoms are the opposite.

Causes of the disease

2. Brain injuries - the disease can develop a couple of hours or weeks after the injury.

3. Infectious diseases - mental disorders can be caused by intoxication after suffering from mumps, influenza, Lyme disease, malaria, leprosy.

4. Intoxication of the brain - often associated with the use of various substances, such as drugs (amphetamine, heroin, LSD, opium, PCP) and medications (corticosteroids, cardiac glycosides, sulfa and anti-tuberculosis drugs, diuretics, NSAIDs, clonidine, H2-histamine blockers, antibiotics).

5. Alcoholism - psychosis, as a consequence of constant consumption of alcohol in large quantities, is not uncommon, and poisoning of the body and disruption of the functioning of nerve cells occurs.

6. Pathologies of the nervous system: epilepsy, multiple sclerosis, Alzheimer's disease, stroke, temporal lobe epilepsy and Parkinson's disease.

7. Diseases that occur with severe pain: sarcoidosis, ulcerative colitis, myocardial infarction.

8. Brain tumors - compressing brain tissue, disrupting the transmission of nerve impulses and blood circulation.

9. Systemic diseases: systemic lupus erythematosus, rheumatism.

10. Severe attacks of bronchial asthma.

11. Hormonal disorders due to childbirth, abortion, dysfunction of the thyroid gland, ovarian pituitary gland, adrenal gland and hypothalamus.

12. Deficiency of vitamins B1 and B3 and electrolyte imbalance caused by changes in the content of calcium, potassium, magnesium and sodium.

13. Mental trauma (stress) and nervous exhaustion (lack of sleep, overwork).

Treatment

Normotimics (actinerval, contemnol);

Benzodiazepines (zopiclone, oxazepam);

Anticholinergics (cyclodol, akineton);

Antidepressants (sertraline, paroxetine).

Take medications prescribed by the doctor;

Maintain a daily routine;

Regularly attend psychotherapy classes;

Exercise daily (swimming, running, cycling);

TO schizophrenic psychoses include mental illnesses leading to personality disintegration. At the same time, characteristic disorders of thinking, perception and affective sphere develop. Intellectual abilities and consciousness are usually not impaired, but cognitive impairment often develops during the course of the disease.

Due to the unknown etiology of schizophrenic psychoses modern classification schemes, such as ICD-10 (WHO) and DSM-3R (APA), are guided by symptoms and time criteria when establishing a diagnosis. According to the ICD-10 diagnostic guidelines, a diagnosis of schizophrenic psychosis is justified if there is at least one of the specific symptoms (or two or three less specific ones) from symptom groups 1-4 listed below or at least two symptoms from groups 5-8.

These symptoms should be evident almost constantly for a month or longer.
1. Echo of thoughts, insertion or subtraction of thoughts, influxes of thoughts.
2. Delirium of influence, control, feeling of being done, clearly related to movements of the body or limbs or to certain thoughts, actions and sensations; delusional perception.
3. Commentary voices discussing the patient and his behavior, or voices emanating from some part of the body.
4. Persistent delusional ideas that are not associated with a given culture and completely inconsistent with reality, such as identifying oneself with religious or political figures, the idea of ​​having superhuman powers and capabilities (for example, the ability to control the weather or contact with aliens).
5. Constant hallucinations in any sphere of feelings, accompanied by either unstable or not fully formed delusional ideas without clear affective manifestations, or persistent overvalued ideas that appear daily for weeks or months.
6. Breaks in thoughts or interference in the thought process, leading to interrupted speech and neologisms.
7. Catatonic symptoms such as agitation, stereotypical rigidity or waxy flexibility (flexibilitas cerea), negativism, mutism and stupor.
8. Negative symptoms such as apathy, poor speech, flattened and inappropriate emotional reactions (which usually leads to social withdrawal and decreased social productivity). It should be obvious that these symptoms are not due to depression or antipsychotic treatment.

a - self-portrait of a 54-year-old patient suffering from a hallucinatory-paranoid form of schizophrenia since the age of 11
b - drawing of the same patient - plan of the city of New York.

Moreover, in accordance with diagnostic criteria ICD-10 The following clinical subtypes of schizophrenic psychoses can be distinguished:
F 20.0 Paranoid
F 20.1 Hebephrenic schizophrenia
F 20.2 Catatonic schizophrenia
F 20.3 Undifferentiated schizophrenia
F 20.5 Residual schizophrenia (chronic undifferentiated schizophrenia)
F 20.6 Simple schizophrenia

Regardless of this division into clinical subtypes of schizophrenia Based on psychopathological symptoms and the nature of the course, other classification options for schizophrenic psychoses were developed (Leonhard, Crow, Andreasen, Kay). Of particular importance for the treatment and dynamics of schizophrenia in childhood and adolescence is the concept of positive (type I) and negative (type II) schizophrenia. The table shows the most important psychopathological symptoms characteristic of type I and type II schizophrenia.

At the same time positive and negative symptoms are in no way specific to schizophrenic psychosis - they are also observed in psychoorganic syndromes, depressive syndromes, personality disorders and neuroses (Angst et al.). Negative symptoms dominate within schizophrenic psychoses in young children (5-10 years) and in children and adolescents with below average cognitive development.

Epidemiology of schizophrenic psychoses

Results from several studies on the epidemiology of schizophrenic psychoses can be summarized as follows:
1. The prevalence of schizophrenia with primary manifestation before the age of 12 is less than 1 in 10,000 children. Thus, it is less common than early childhood autism (Burg, Kerbeshian).
2. Schizophrenic psychoses with primary manifestation in childhood are 50 times less common than schizophrenia in adults (Karno, Norquist).
3. Schizophrenic psychosis in childhood and prepubertal age is a rare phenomenon, but in adolescents it is a relatively common disease. The primary manifestation of schizophrenic psychoses in 2.4% of cases occurs between the 5th and 14th years of life and in 22.1% - between the 15th and 19th years (Remsclrmidt).
4. The gender distribution in childhood is more favorable for boys, and in adolescence this difference apparently smoothes out (Remschmidt et al.).

Aspects of psychopathology in the development of schizophrenic psychoses

Schizophrenic psychoses in childhood and adolescence must always be considered in the context of development processes. Symptoms in a particular patient are often determined by the phase of its development. In this case, it is necessary to distinguish manifestations in childhood from those that occur in adolescents. Age and level of development from a modern point of view are considered as factors that greatly influence the clinical picture of psychoses in childhood and adolescence (Remschmidt, Remschmidt et al.). Taking into account aspects of developmental psychopathology, schizophrenia includes both independent psychoses of childhood, for example, early childhood catatonia (Leonhard), and mental disorders that develop into schizophrenia when they manifest in childhood until prepuberty. In general (Kanner), childhood psychoses are divided into:
1) early childhood autism not related to schizophrenia,
2) disintegrative psychoses of childhood as primary organically caused disorders and
3) childhood forms of schizophrenia.

Knowledge of the cognitive and emotional characteristics of the relevant age period and an accurate analysis of developmental tasks are prerequisites for understanding psychoses and their symptoms such as delusions and hallucinations. The latter are characterized by typical age-related features: in children they are less systematized and associated with the world of children's fantasies, which makes it necessary to clearly distinguish them from normal childhood experiences.

U teenagers so-called pubertal crises and maturation crises can precede schizophrenic psychoses, and also initially mask them (Remschmidt, Martin). During teenage crises, we are talking about normal variants of experiences and behavior in the form of distorted self-esteem, feelings of guilt, feelings of inferiority, conflicts associated with physical and mental self-esteem, often causing self-harm, suicidal attempts, leaving home and oppositional behavior at the behavioral level ( Remschmidt). Deviations and crises that arise when overcoming problems can be the initial manifestation of psychosis and participate in the development of its symptoms. The onset of schizophrenic psychosis, according to modern data, can be explained by the interaction of the patient’s predisposition and premorbid personality characteristics with aggravating life circumstances and family factors, which leads to failures in overcoming problems and decompensation of psychosis.

Significant signs of predisposition to schizophrenic psychoses are:
limited processing of information (impaired attention, increased distractibility with extraneous stimuli, difficulties in their selection);
inadequate autonomic reactions (hypo- or hyperexcitability, insufficient adaptive abilities of the autonomic nervous system);
limited social competence;
insufficient defense mechanisms.