Schizophrenia

Schizophrenia is a progressive disease characterized by gradually increasing personality changes (autism, emotional impoverishment, the emergence of strangeness and freak), other negative changes (dissociation of mental activity, mental disorders, a drop in energy potential) and various in severity and severity of productive psychopathological manifestations (affective, neurotic - and psychopathic, delusional, hallucinatory, hebephrenic, catatonic).

The etiology, pathogenesis of schizophrenia is not well understood. An important role is played by constitutional-genetic factors, as well as the sex and age of patients. The most severe forms of the disease are found predominantly in men, less progressive, in women. Schizophrenia, which began in adolescence, proceeds more malignantly than in adults.

Symptoms of schizophrenia depend on the stage of development and the form of the course of the disease. There are three main forms of schizophrenia: continuous flow, paroxysmal-progredient (shuboobraznuyu) and recurrent (periodic).

With continuous sycophrenia, there is a gradual increase in painful manifestations with a consequent change of neurotic, hallucinatory-delusional and catatonegerebrain disorders. With slow sluggish schizophrenia, the development of the process for a long time does not lead to gross changes in the personality and marked violations of social adaptation. The clinical picture is dominated by nonpsychotic symptoms (obsessions, phobias, hysterical, senestroipochondrial, depersonalization manifestations, overvalued ideas); The exception is paranoid schizophrenia, which proceeds with the predominance of delusions of jealousy, invention, hypochondriacal, love, etc. With greater progression of the process and the prevalence of such hallucinatory-paranoid disorders in the clinical picture as delirium of persecution, grandeur, physical impact, the phenomenon of mental automatism (paranoid schizophrenia) , Increasing negative changes and intellectual decline, culminating in adverse cases, the formation of the final state. Malignant schizophrenia, beginning in childhood and adolescence, is characterized by the early appearance of negative changes, the complication of the clinical picture due to the adherence of malosystematized delusional disorders, hallucinatory, catatonic and catatonic-hemophrenic symptoms, the rapid development of the disease, after 1-4 years ending in a final condition with a gross emotional defect , Regress of behavior and phenomena of apathic dementia.

Paroxysmal-progredient (shuboobraznaya) schizophrenia is characterized by attacks separated by remissions; During the remission, the changes in personality appear distinctly [after one or more attacks (fur coats)]. This type of disease is characterized by the following types of attacks: an acute developing syndrome of mental automatism with physical delusions, dramatization, false recognition; Acute delusional (with delirium of jealousy, persecution, poisoning); Hallucinatory; Catatonic-paranoid, catatonic and catatonegebefrene. Attacks with a predominance of affective, neurotic and psychopathic disorders are also observed. The course of the coat-like schizophrenia is diverse. Along with the tendency to reduce and worsen remissions and the transition to continuous flow, it is possible, in addition to the tendency observed in adverse events, to occur following protracted recurrent attacks of late remissions with a long process stabilization. There are also variants of the disease with rare seizures, manifesting mainly during periods of age crises.

Recurrence (periodic) schizophrenia manifests itself periodically arising attacks, which do not lead to gross negative changes and are replaced by deep remissions. The most typical are depressive-paranoid seizures with delirium of condemnation, meanings, staging, acquiring imagery, fantasy, and onyeroid-catatonic attacks with onyeroid obscuration of consciousness as the anxiety-depressive affect increases; Comparatively rare are attacks of febrile catatonia, occurring with a high temperature and significant metabolic disorders. There are also intermittent seizures of atypical depression and mania, separated by thymopathic remissions (circular schizophrenia).

Schizophrenia most often has to differentiate from symptomatic psychosis, manic-depressive psychosis, reactive states, neuroses and psychopathies. Diagnosis of schizophrenia is facilitated by the presence of gradual or step-like increasing personality changes, as well as disturbances in thinking, delusions of abstract, metaphysical content, the phenomenon of mental automatism, catatonic-neural symptomatology.

Treatment of schizophrenia depends on the clinical picture, course and stage of the disease. At the expressed psychotic conditions disturbing adaptation of patients and usually demanding hospitalization, use psychotropic agents, and also shock methods of treatment. Insulinocomatous and electroconvulsive therapy is used both for acute catatonic, affective and affective-delusional, and for some protracted states that are resistant to psychotropic drugs. In cases of slower development of the process, in the period of remission, as well as in shallow remissions, drug treatment is carried out in combination with psychotherapy and occupational therapy. In schizophrenia with a predominance of neurosis-like disorders, tranquilizers [diazepam (seduxen), sibazone (relanium), oxazepam (tazepam), chlordiazepoxide (elenium) 10-40 mg / day, phenazepam 1-5 mg / day] in combination with small doses Neuroleptics [thioridazine (sonapaks), eglonil, chlorprotixen, moden-depot, imap] or antidepressants; With resistance to psychopharmacological drugs atropinokomatoznuyu therapy. In psychopathic conditions nuleptil (10-40 mg / day), as well as small doses of aminazine, trifazine or thioproperazine (mazheptil) are prescribed. For the treatment of hallucinatory-paranoid, catatonic and catatonegebefrenal conditions, neuroleptics are used (aminazine 150-400 mg, triftazine 15-50 mg, haloperidol 12-30 mg, thioproperazine 10-40 mg, leponex 100-300 mg and Etc.) in tablets and parenterally. In affective-delirious states, the combination of antidepressants (amitriptyline, melipramine, petilil, gerfonal 150-300 mg / day) with antipsychotics is effective.

The prognosis of acute attacks of the disease that are acute and occurring with violent psychotic symptoms is more favorable than in the case of prolonged flow with increasing apathy and a drop in the energy potential, with a predominance of systematic delirium, persistent hallucinosis, catatonegebephrenic disorders in the clinical picture. With supportive therapy with psychotropic drugs, preventive use of lithium salts and finlepsin, and the implementation of measures for social and labor adaptation, the prognosis improves.