SCHIZOPHRENIA is a group of mental diseases of unclear etiology, in the development of which, apparently, common endogenous mechanisms play a certain role and which do not manifest themselves until a certain period of life. The disease, as a rule, leads to the formation of specific personality changes ("schizophrenic mental defect" - isolation, emotional impoverishment, decreased activity, the appearance of oddities in behavior, eccentricity) that make the patient difficult to adapt in society, reduce his ability to work, often lead to disability . The beginning of schizophrenia before the age of 10 and after 30 years is quite rare; more often she manifests in adolescence and youth. The course and outcome of schizophrenia also differ in their diversity: from mild non-psychotic forms that occur with neurosis-like symptoms and preservation of working ability, to a malignant course with frequent psychosis and an outcome to dementia . In recent years, there has been a shift towards more "milder" forms of schizophrenia (neurosis-like or psychopath-like with rudimentary hallucinatory-delusional manifestations).
Paranoid schizophrenia usually begins after the age of 20 years and is manifested by such forms of delirium as delusions of exposure, persecution and relationships. Hallucinations are more often auditory verbal; imperative hallucinations are also typical, which can make a patient dangerous for himself or others. As the disease progresses, the phenomena of an emotional-volitional personality defect appear and strengthen.
Gebefrenicheskaya form begins in adolescence or adolescence. The clinic is characterized by ridiculous foolishness, rough antics, exaggerated grimaces. At times motor excitement flashes; patients tend to shamelessly naked in front of strangers, they masturbate in front of everyone, are unclean and untidy. Crazy statements are fragmentary, hallucinations are episodic. This form is distinguished by a malignant course and a schizophrenic defect of the psyche develops quickly (in 1–2 years) in the form of an apatoabulistic syndrome (a combination of lack of will with indifference and loss of desires).
The catatonic form is manifested by the alternation of catatonic excitation (see Catatonia) with a state of immobility and complete silence (see Stupor). Consciousness during a stupor can be fully preserved and subsequently, when the stupor passes, the patients tell in detail about everything that happened around. Catatonic disorders can be combined with hallucinatory-delusional experiences, and in the case of an acute course, the oneiric syndrome develops.
The simple form is manifested by gradually increasing symptoms, such as the loss of former interests (friends, hobbies, entertainment), inactivity and indifference to everything, isolation from real events. Patients may continue to go to school or to work for some time, but their productivity quickly falls and gradually, closing up at home, they become lonely and silent. No events cause an emotional response from them, and the attitude towards relatives becomes hostile or even aggressive. Violations of thinking are characterized by sudden stops, "breaks" in the middle of a phrase, or "slipping" on an unexpected topic. Patients come up with new words that only they can understand. Occasionally there are occasional delusional experiences or fragmentary hallucinations .
Sluggish schizophrenia occurs depending on the characteristics of the clinic in two versions: as neurosis-like and psychopathic. Neurosis-like schizophrenia resembles a prolonged neurosis of obsessive states at the clinic; when started in adolescence and youth, it may take the form of anorexia or depersonalization. Obsessions differ from neurotic more intensity, the absurdity of protective rituals; phobias lose their emotional, intuitive component. Hypochondriacal complaints become pretentious and absurd in nature (“the brain has dried up”, “the stomach has melted”, etc.). Asthenic syndrome does not decrease as a result of rest. Along with neurosis-like symptoms, relationship ideas can form, when it seems to patients that everyone is laughing at them, looking at them, etc. The clinical picture of psychopathic schizophrenia is similar to different types of psychopathies.
The most effective is psychopharmacological therapy, which takes into account both the leading syndrome and the form of the disease. Maintenance therapy is carried out for many months and years; as a rule, small doses of those drugs are used with which remission was achieved. It is rational to carry it out with the help of long-acting psychopharmacological preparations (moditen-depot, piportil, etc.). An important role is played by timely labor and social rehabilitation (recruitment to work in medical and production workshops, disability registration, improvement of living conditions, etc.). If the disease takes a chronic and prolonged course, proceeds with severe and frequent exacerbations, then it is advisable to establish a dispensary observation for such patients and they are subject to psychiatric registration. Of great importance for patients discharged from psychiatric hospitals and in a state of remission is outpatient supportive therapy with psychopharmacological agents. The treatment of such patients in whom the course of the disease has become monotonous can also be carried out by a medical assistant, if he has clear instructions from the doctor regarding a particular patient.