Schizophrenia

Schizophrenia

Schizophrenia– a mental illness of a continuous or paroxysmal course, begins mainly at a young age, is accompanied by characteristic personality changes (autization, emotional-volitional disorders, inappropriate behavior), mental disorders and various psychotic manifestations. The diagnosis is established on the basis of the clinical picture, anamnesis data, exclusion of an organic factor that can cause a clinically similar disorder. The frequency is 0.5% of the population. 50% of beds in psychiatric hospitals are occupied by patients with schizophrenia. Genetic aspects. A priori, polygenic inheritance seems to be the most probable. The unscientific application of a broader definition of schizophrenia leads to an increase in the estimate of the population frequency to 3%. The existence of several loci has been proven or assumed, contributing to the development of schizophrenia (see Appendix 2. Hereditary diseases: mapped phenotypes). Classification

• • Forms
  • Paranoid – the most common form, the clinical picture is dominated by hallucinatory-paranoid syndrome, mental automatism syndrome
  • Hebephrenic – hebephrenic syndrome prevails
  • Catatonic – catatonic syndrome prevails in the clinical picture
  • Simple – negative symptoms predominate without psychotic episodes
  • Residual – an increase in negative symptoms as a result of one or more psychotic episodes suffered in the past
  • Flow types
  • Continuous – no clear remissions, steady progression of negative symptoms
  • Fur coat – the presence of complete remissions against the background of the progression of negative symptoms
  • Recurrent – there are no negative symptoms, affective disorders are expressed in exacerbations, complete remissions.

The clinical picture is polymorphic. Various combinations of symptoms and syndromes are observed. Negative symptoms are decisive in the diagnosis.

Negative symptoms

• • Thinking disorders
  • Diversity. Minor features of ordinary things seem to be more significant than the subject as a whole or the general situation. It is manifested by ambiguity, vagueness, thoroughness of speech.
  • Fragmentation. A gradual or sudden deviation in the thought process towards random associations, a tendency to symbolic thinking, characterized by the coexistence of the direct and figurative meaning of concepts. There are sudden and incomprehensible transitions from one topic to another, a comparison of the incomparable. In expressed cases, speech is devoid of semantic meaning and is inaccessible to understanding with its outwardly correct construction.
  • Sperrung (blockage of thinking) – a sudden break in the thought process.
  • Razonerstvo – ornate fruitless reasoning.
  • Emotional-volitional disorders
  • Emotional-volitional defect. Fading of emotional reactions, indifference, indifference to the environment. Paradox, inadequacy of emotional reactions. Loss of interest, lack of plans for the future, inactivity.
  • Ambivalence. The coexistence of two opposite tendencies (thoughts, emotions, actions) in relation to the same object in the same person at the same time. It is manifested by the improbability to complete certain actions, to make a decision.
  • Autism. Unconscious withdrawal from the outside world, preference for his own world, divorced from reality, thoughts and fantasies. Manifested by passivity, lack of initiative, lack of sociability.
  • Personality changes are the result of the progression of negative symptoms. Manifested in pretentiousness, mannerisms, absurdity of behavior and actions, emotional coldness, paradoxicality, lack of sociability.

Positive (psychotic) manifestations

• • Hallucinatory-paranoid syndrome. A combination of poorly systematized, non-consequent delusional ideas, more often persecution, with a syndrome of mental automatism and / or verbal hallucinations.
  • Syndrome of mental automatism (Kandinsky-Clerambault syndrome)
  • Alienation or loss of belonging to one’s own
  • I
  • own mental processes (thoughts, emotions, physiological functions of the body, movements and actions performed), the experience of their involuntariness, doneness, imposition from the outside. Symptoms of openness, withdrawal of thoughts and mentism (involuntary influx of thoughts) are characteristic.
  • Pseudo-hallucinations
  • Delusions of influence, persecution. They observe the delusions of metamorphosis (the violent transformation of the subject into another person, animal or inanimate object), transitivism (everything personally experienced by the subject is also experienced by others).
  • Capgras Syndrome (delusional belief that people around them are able to change their appearance for a specific purpose).
  • Affective paranoid syndrome
  • Depressive-paranoid syndrome is manifested by a combination of depressive syndrome, delusional ideas of persecution, self-accusation, verbal hallucinations of an accusatory nature.
  • Manic-paranoid syndrome is manifested by a combination of manic syndrome, delusional ideas of grandeur, noble birth, verbal hallucinations of an approving, praising character.
  • catatonic syndrome
  • Catatonic stupor. Characterized by increased muscle tone, catalepsy (freezing for a long time in a certain position), negativism (unreasonable refusal, resistance, opposition to any outside influence), mutism (lack of speech with a intact speech apparatus).
  • catatonic excitement. Characterized by an acute onset, suddenness, randomness, lack of focus, impulsiveness of movements and actions, senseless pretentiousness and mannerisms of movements, ridiculous unmotivated exaltation, aggression.
  • hebephrenic syndrome. Foolish, ridiculous behavior, mannerisms, grimacing, lisping speech, paradoxical emotions, impulsive actions are characteristic. May be accompanied by hallucinatory-paranoid and catatonic syndromes.
  • The depersonalization-derealization syndrome is characterized by a painful experience of a change in one’s own personality and the surrounding world, which cannot be described.

Research methods. There is no effective test to diagnose schizophrenia. All studies are directed mainly to the exclusion of an organic factor that could cause a disorder.

• • Laboratory research methods:
  • general blood and urine test
  • biochemical blood test
  • study of thyroid function
  • blood test for vitamin B12 and folic acid
  • blood test for the content of heavy metals, drugs, psychoactive drugs, alcohol
  • Special Methods
  • CG and MRI: exclude intracranial hypertension, brain tumors
  • EEG: rule out temporal lobe epilepsy
  • Psychological methods (personality questionnaires, tests [for example, Rorschach tests, MMPI)). Differential Diagnosis
  • Somatoneurological diseases
  • Substance abuse (amphetamines, hallucinogens, belladonna alkaloids, alcohol, barbiturates, cannabinoids, psychostimulants)
  • temporal lobe epilepsy
  • Other diseases (porphyria, vitamin B|2 deficiency, carbon monoxide poisoning, heavy metals, cerebral lipoidosis, herpetic encephalitis, homocystinuria, Huntington’s disease, Hallervorden-Spatz disease, metachromatic leukodystrophy, neurosyphilis, normotensive hydrocephalus, pellagra, SLE, Korsakoff’s syndrome, Wilson, brain tumors)
  • Mental illnesses:
  • reactive psychosis
  • simulation
  • mood disorders
  • schizoid personality disorder
  • schizoaffective disorders
  • paranoia.

Treatment:

• • Psychotherapy individual, family, group.
  • Socio-professional rehabilitation.
  • Psychopharmacotherapy
  • Drugs, doses, duration of treatment are selected individually, strictly according to the indications, depending on the symptoms, the dynamics of the mental state, the severity of the disorder and the stage of the disease.
  • Preference should be given to a product that has previously been effective in this patient.
  • The duration of treatment is 4-6 weeks, then, if there is no effect, a change in the treatment regimen.
  • Antipsychotics: chlorpromazine (chlorpromazine), levomepromazine, clozapine (azaleptin), periciazine, haloperidol, haloperidol decanoate, triftazine, perphenazine (etaperazine), thioproperazine, piportil (pipothiazine), trifluperidol, sulpiride, carbidine, frenolone (methophenazate), fluorophenazine decanoate, fluspirilene, penfluridol, pimozide, thioridazine, alimemazine.
  • Lithium preparations: lithium carbonate, lithium oxybutyrate.
  • TAD: amitriptyline, clomipramine, ludiomil (maprotiline).
  • Psychostimulant: sidnocarb.
  • Tranquilizers: diazepam (sibazon), phenazepam. Complications in the treatment of neuroleptics
  • Akineto-hypertonic syndrome
  • . Clinic: mask-like face, infrequent blinking, stiffness of movements
  • Treatment: cyclodol, akineton, parkopan.
  • Hyperkineto-hypertonic syndrome
  • Clinic: akathisia (restlessness, restlessness in the legs), tasikinesia (restlessness, the desire to constantly move, change position), hyperkinesis (choreiform, athetoid, oral)
  • Treatment: cyclodol, akineton, parkopan.
  • Dyskinetic Syndrome
  • Clinic: oral dyskinesias (tension of chewing, swallowing muscles, muscles of the tongue, there is an irresistible desire to stick out the tongue), oculogeric crises (painful rolling of the eyes)
  • Treatment: cyclodol (6-12 mg / day), caffeine sodium benzoate 20% solution 2 ml s / c, chlorpromazine 25-50 mg / and.
  • Chronic dyskinetic syndrome
  • Clinic: hypokinesia, increased muscle tone, hypomimia in combination with local hyperkinesis (complex oral automatisms, tics), decreased urges and activity, akairiya (obtrusiveness), emotional instability
  • Treatment: nootropics (piracetam 1200-2400 mg/day for 2-3 months), multivitamins, tranquilizers.
  • Malignant neuroleptic syndrome
  • Clinic: dry skin, acrocyanosis, sebaceous hyperemic face, forced posture – on the back, oliguria, increased blood clotting time, increased residual nitrogen in the blood, renal failure, decreased blood pressure, increased body temperature
  • Treatment: infusion therapy (rheopolyglucin, hemodez, crystalloids), parenteral nutrition (proteins, carbohydrates).
  • Intoxication delirium develops more often in men over 40 years of age (with a combination of chlorpromazine, haloperidol, amitriptyline. Treatment – detoxification.

Forecast for 20 years: recovery – 25%, improvement -30%, care and / or hospitalization required – 20%

• • 50% of those with schizophrenia attempt suicide (15% are fatal)
  • The older the age of onset, the better the prognosis
  • The more pronounced the affective component of the disorder, the more acute and shorter the attack, the better it can be treated, the more likely it is to achieve a complete and stable remission.

Synonyms. Bleuler’s disease, Dementiapraecox, Discordant psychosis, Early dementia

See also Parkinsonism drug

ICD. F20 Schizophrenia

MSH 181510,104760, 126451, 600511, “600850

Notes.

• pfropfschizophrenia (from German Pfropfimg – vaccination) – schizophrenia developing in an oligophrenic
• oligoschizophrenia o pfropfgebephrenia
• schizophrenia vaccinated
• Huber’s senestic schizophrenia is a schizophrenia with a predominance of senestopathies in the form of sensations of burning, constriction, tearing, turning over, etc.
• schizophrenia-like psychosis (pseudo-schizophrenia) is a psychosis that is similar or identical in clinical presentation to schizophrenia.
• schizophrenia-like syndrome is a general name for psychopathological syndromes similar in manifestations to schizophrenia, but occurring in other psychoses.
• nuclear schizophrenia (galloping) – the rapid development of emotional devastation with the disintegration of pre-existing positive symptoms (end state).