SCHIZOPHRENIA is a group of mental diseases of unknown etiology, in the development of which a certain role is played, apparently, by common endogenous mechanisms and which do not appear 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 strange behaviors, eccentricity), which create difficulties for the patient to adapt in society, reduce his ability to work, and often lead to disability . The onset of schizophrenia before 10 years of age and after 30 years is quite rare; more often it manifests in adolescence and youth. The course and outcome of schizophrenia is also diverse: from mild nonpsychotic forms that occur with neurosis-like symptoms and continued disability, to a malignant course with frequent psychoses and an outcome in dementia . In recent years, there has been a shift towards more “mild” forms of schizophrenia (neurosis-like or psychopathic with rudimentary hallucinatory-delusional manifestations).
Paranoid schizophrenia usually begins after the age of 20 and is manifested by such forms of delirium as delirium of exposure, harassment, and attitude. Hallucinations are more often auditory verbal; imperative hallucinations are also typical, which can make the patient dangerous to themselves or others. As the disease develops, the phenomena of an emotional-volitional personality defect appear and intensify.
Hebephrenic form begins in adolescence or youth. The clinic is characterized by absurd foolishness, rude antics, exaggerated grimaces. At times, motor agitation flashes; patients tend to shamelessly expose themselves to strangers, they masturbate in front of everyone, are unclean and untidy. Delusional remarks are sketchy, hallucinations are episodic. This form is characterized by a malignant course and a schizophrenic mental defect in the form of apatoabulic syndrome (a combination of lack of will with indifference and loss of desire) develops rapidly (in 1-2 years).
The catatonic form is manifested by the alternation of catatonic excitement (see Catatonia) with a state of immobility and complete silence (see Stupor). Consciousness during a stupor can be fully preserved and later, when the stupor passes, 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, oneiric syndrome develops.
The simple form is manifested by such gradually increasing symptoms as loss of previous interests (friends, hobbies, entertainment), inaction and indifference to everything, isolation from real events. Patients may continue to go to school or work for some time, but their productivity decreases rapidly and gradually, closing at home, they become lonely and silent. No events evoke an emotional response in them, and their attitude towards their relatives becomes hostile or even aggressive. Impaired thinking is characterized by sudden stops, “cliffs” in the middle of a phrase, or “slipping” on an unexpected topic. Patients come up with new words that only they understand. Occasionally, episodic delusional experiences or fragmentary hallucinations occur.
Sluggish schizophrenia proceeds, depending on the characteristics of the clinic, in two versions: as neurosis-like and psychopathic. Neurosis-like schizophrenia resembles in a clinic a protracted neurosis of obsessive states; at the beginning in adolescence and adolescence, it can take the form of mental anorexia or depersonalization. Obsessions differ from neurotic ones in greater intensity and absurdity of protective rituals; phobias lose the emotional, understandable to others component. Hypochondriacal complaints become artsy and ridiculous 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, ideas of attitude can form when patients feel that everyone is laughing at them, looking at them, etc. According to the clinical picture, psychopathic schizophrenia is similar to different types of psychopathies.
The most effective is psychopharmacological therapy, which is carried out taking 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 with which remission was achieved are used. If possible, it is rational to carry out it with the help of psychopharmacological drugs of prolonged action (moditene depot, piportil, etc.). An important role is played by timely labor and social rehabilitation (involvement in work at medical-production workshops, registration of disability, improvement of living conditions, etc.). If the disease takes a chronic and protracted course, proceeds with severe and frequent exacerbations, then it is advisable to establish follow-up for such patients and they are subject to psychiatric records. Of great importance for patients discharged from psychiatric hospitals and in remission is the ongoing outpatient maintenance 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 a doctor regarding a specific patient.