Symptoms of schizophrenia
Regarding the topic of symptoms and signs of schizophrenia , it is necessary to understand that the disease, “… during its onset and initial development, is clinically extremely polymorphic”, and it can be quite difficult to recognize it even for an experienced psychiatrist. That is why in psychiatry it is customary to single out typical forms with vivid symptoms and signs of schizophrenia in each specific “cliché”.
In particular, you should be aware that at the initial stage of the development of the disease, the symptoms of schizophrenia appear chaotically and cannot be attributed to a specific type. Moreover, the founder of the modern nosological concept in psychiatry and the classification of mental disorders, the psychiatrist “…Emil Kraepelin , when initially distinguishing schizophrenia as a separate nosological unit, relied on cases that had gone far, with obvious personality changes.”
It was on the basis of such pronounced signs of schizophrenia that the first classification was created, which included only three types of the disease:
- early dementia;
At the end of his career, the German psychiatrist expanded the classification, adding seven more types to it, which indicates “… the diversity and difficulty in systematizing the clinical manifestations of schizophrenia.”
Since the middle of the 20th century, there has been a great interest in scientific research in psychiatry, which was carried out with the aim of identifying the symptoms of schizophrenia and the characteristics of its development, both in order to study the disease, and to effectively apply this knowledge in the treatment of schizophrenia. For example, to predict the course in each case and the results of individually selected treatment.
Symptoms of schizophrenia in adults, adolescents and children
Given the variety of signs of schizophrenia, it is necessary to “keep in mind” the unique life experience of a person, the features of family education and other factors that influence the formation of ideas about the world around. Otherwise, there is a risk of speculative judgments that are not relevant to the issue of diagnosing schizophrenia. Unfortunately, in an environment far from psychiatry, one may encounter such attribution of symptoms of schizophrenia to people who have a religious upbringing, brought up in value systems that are different from the secular world.
But, of course, one cannot deny the fact that the signs of schizophrenia can have “cultural” and “age” features and, accordingly, differ in children, adolescents and adults. In other words, the monster under the bed is unlikely to compete with the idea of a global conspiracy to drive a particular adult crazy.
Symptoms of schizophrenia in children and adolescents
Schizophrenia can develop from birth. However, recognizing the symptoms and signs of schizophrenia in infancy or childhood can be very difficult. By the way, this is a documentary about Janie , who has this disease since birth. And this is not an isolated case in the world. In Russia alone, the ratio of children and adolescents with schizophrenia aged 0 to 14 years is “…1.66 per 10,000 child population.”
The characteristic symptoms of schizophrenia in children and adolescents (adjusted, for example, for upbringing, characteristics of the age period, the general development of the child) include:
- catatonic disorders;
- broken speech, neologisms;
- loss of interest
- social autism ;
- delusions of influence, influence or mastery;
- echo of thoughts, their translation;
- auditory hallucinations;
- crazy ideas.
Before the onset of schizophrenia, the first acute psychotic episode, one can notice clear prodromal signs of schizophrenia in children and adolescents. These include mild disorders of thinking, speech, hearing, changes in the nature of movements. Outwardly, you can see that the child ceases to show interest in games and communication with peers, he develops anxiety.
Symptoms and signs of schizophrenia in men
The opinion that the early development of schizophrenia is characteristic of men is formed from an assessment of the data of “… the first hospitalization.” The difference ranges from 1 to 10 years compared with early screening of women with symptoms of schizophrenia ( Hafner et al ., 1989). Of course, statistics should not be treated with all severity, but they still show a certain picture.
It is noteworthy that the symptoms and signs of schizophrenia in married men appear much later than in single men. The same can be said about women. However, women with developing schizophrenia a priori rarely get married.
The main symptoms and signs of schizophrenia in men are negative (observed in the vast majority of cases; they make themselves felt 4–6 years before the first hospitalization):
- monotonous voice;
- fixed facial expression;
- reduced need for communication;
- loss of ability to enjoy;
- poor ability to plan things;
- neglect of hygiene.
In other words, for many years such a person may need psychiatric help, but not understand it. Relatives and the environment may consider him lazy, indifferent to life, a “tired” person.
Symptoms and signs of schizophrenia in women
It is widely known that from psychiatric hospitals “… more recovered women than men are always discharged.” Many studies, including the International Pilot (WHO), have found that a favorable outcome of the course of the disease is almost always associated with female patients. This is usually associated with the late onset of schizophrenia in women, which is characterized by a milder course compared to men. Also, an important role is played by some biological features of the functioning of the female body associated with estrogens, which have “… an antipsychotic effect on the secretion of dolamine and on the level of prolactin, thus reducing vulnerability to schizophrenia.”
The characteristic symptoms and signs of schizophrenia in women include:
- negative attitude towards life;
- hostility to relatives and strangers;
- decreased concentration;
- violation of the menstrual cycle;
- brief episodes of delirium;
- slight misperceptions.
Otherwise, the symptoms and signs of schizophrenia in women do not differ from the “male” version of the manifestation of the disease. Women, as a rule, withdraw into themselves, cease to be interested in the opposite sex, refuse to eat, neglect hygiene rules, lose interest in previously beloved activities, and become passive “observers of life.”
Next, we propose to consider the most characteristic signs of some clinical forms of schizophrenia according to ICD-10. Again, it is not necessary to take the above diagnostic criteria for completeness of information, since the forms “… can individually vary widely in severity and determine the diversity of the clinical picture of the disease.”
Symptoms of paranoid (paranoid) schizophrenia
In addition to general signs, the symptoms of paranoid (paranoid) schizophrenia (some of which we have listed above; or see ICD-10 F20.0–F20.3) include delusions of a special nature:
- meanings and relationships;
- bodily transformation;
- special mission;
- high origin.
“Voices” also refer to signs of paranoid (paranoid) schizophrenia. They may be commanding or threatening; delusions of taste, smell, and bodily sensations may be present.
Symptoms of sluggish schizophrenia
The striking signs of sluggish schizophrenia include features of the “style” that runs counter to generally accepted norms, the norms of recognized subcultures. Such a person can give the impression of being emotionally cold, detached from reality. His appearance may contain eccentric details, emphasizing outbursts of non-standard behavior.
The most noticeable symptoms of sluggish schizophrenia, which manifest itself episodically, include:
- fancy speech;
- intrusive thoughts;
- quasi-psychotic seizures with hallucinations;
- crazy ideas.
Often such people are attached to strange beliefs of a magical nature that determine their behavior in society; it can be a unique picture of the world, different from the existing ones, or individually supplementing them.
Symptoms of a simple (mild) form of schizophrenia
Identification of signs of a simple (mild) form of schizophrenia takes a lot of time. As a rule, outpatient observation by a psychiatrist for a distance of at least one year is required for diagnosis. Throughout the year, the following symptoms of a simple (mild) form of schizophrenia should persist:
- loss of interest in life;
- social autism ;
- impoverishment of speech;
- impoverishment of facial expressions.
At the same time, such a person should not experience hallucinations, delusional ideas of any kind, abnormal subjective experiences. There should be no history of dementia, other mental disorders caused by organics.
Symptoms of catatonic schizophrenia
The symptoms of catatonic schizophrenia include specific conditions and behaviors that complicate the diagnosis by the reluctance of such people to get in touch with the doctor, and with anyone else. In addition to the general criteria for illness (F20.0–F20.3), any of the following signs of catatotic schizophrenia must be observed at a distance of at least two weeks:
- wax flexibility;
- stupor or mutism ;
- aimless motor activity;
- freezing in unusual positions;
- automatic subordination ;
- “negative” motor activity;
- rigid posture.
Symptoms of neurosis-like schizophrenia
Outpatient observation for signs of neurosis-like schizophrenia lasts at least two years. At this distance, at least four symptoms of neurosis-like schizophrenia should be clearly observed, supplemented by apathy, decreased activity, emotional dullness, and judgments of a paradoxical nature:
- unusual appearance and behavior;
- social isolation;
- magical thinking;
- paranoid ideas;
- obsessions ;
- disturbances of perception by the type of depersonalization- derealization ;
- figurative, excessively detailed or stereotyped thinking;
- rare episodes with severe hallucinations;
- smoothed delusional symptoms.
Symptoms of hebephrenic schizophrenia
Diagnosis requires the presence of general criteria (F20.0–F20.3) and at least one of the specific symptoms of hebephrenic schizophrenia:
- emotional dullness
- or inappropriate emotional reactions;
- aimless, strange behavior
- or thinking disorders (eg, expressed by broken speech).
Hallucinations and delusions do not belong to the characteristic signs of hebephrenic schizophrenia. However, they can be expressed to a fairly mild degree.
List of used literature
1. Snezhnevsky A.V. “Schizophrenia, a series of lectures”.
2. Makushkin E.V., Simashkova N.V. “Schizophrenia (Childhood and Adolescence)”.
3. Russian Society of Psychiatrists. “Schizophrenia, clinical guidelines”.
Symptoms of schizophrenia
Schizophrenia is a fairly common mental disorder. In our country, it occurs in 1% of the total population. There is an opinion that schizophrenia is incurable, as it is a chronic mental illness. However, the statistics show otherwise. It has been established that effective treatment after the first psychotic episode ends in complete recovery in 25% of cases, in 50% it is possible to limit the course of the disease to several episodes, and in 25% a protracted chronic form develops.
If the treatment is carried out by a highly professional specialist using modern methods of treatment, then with early treatment, a stable remission can be achieved in 62% of cases. The term “remission” means that the manifestations and exacerbations of the disease will not be observed. To achieve a good result of treatment, the correct selection of the drug, as well as its dosage, is very important. It is also important that the patient and his environment are responsible for the implementation of the prescribed treatment, which should be carried out regularly and strictly according to the treatment plan prescribed by the doctor. Timely initiation of therapy significantly increases the chances of a cure, and therefore, if there is any suspicion of a mental disorder, it is necessary to urgently seek medical help. Schizophrenia is characterized by two types of symptoms: negative and positive (productive).
Positive symptoms of schizophrenia
Positive symptoms usually appear at the first attack, marking the onset of schizophrenia. Positive symptoms include delusions, hallucinations, depersonalization, and derealization .
With schizophrenia, hallucinations are observed, most often auditory. Auditory hallucinations are the most common form of hallucination and are attributed by many researchers to disturbances in the temporal gyrus. For schizophrenia, auditory pseudo-hallucinations are more characteristic, which are felt by patients as voices in the head (that is, they exist only in the patient’s inner world and are not identified with real objects). And in turn, true auditory hallucinations are projected into the outside world, and the patient believes that he hears sounds or words from somewhere outside (for example, behind the wall of the apartment).
A patient with schizophrenia hears various sounds, conversations. They can be quiet or loud, and are often unpleasant for the patient.
In the case of perception by the patient of commanding voices, they speak of imperative hallucinations. They are the most dangerous, because, following the instructions of these voices, the patient can commit dangerous acts towards himself or others. Often patients try to hide the presence of hallucinations, but they often give themselves away – listen to something, talk to themselves. Thanks to this, others can understand that something is wrong with a person. If a person answers inappropriately, freezes and listens to something for no apparent reason, then there is a high degree of probability that he has hallucinations.
Delusions are stable pathological beliefs that are not amenable to external adjustment. Delusions are classified according to the orientation of the patient’s beliefs. For example, the patient is convinced that his spouse is cheating on him – this is the delusion of jealousy. If he believes that he is being persecuted in order to kill or compromise, this is delusional persecution, etc. This mental disorder can be dangerous, since in this state a person often commits inappropriate acts. If a person develops a delusional disorder, then close people can note a number of oddities in his behavior and sound the alarm. With the development of delirium, the appearance of exotic interests or their sudden change, excessive passion for esotericism, religion is characteristic. Thoughts may be expressed about persecution by the secret services or real people to whom, for example, the patient owes money. A sick person can seriously believe that he is endowed with superpowers, that they want to harm him or his loved ones, etc.
The main criterion for delirium is the patient’s complete confidence that he is right; it is usually impossible to convince him, no matter how absurd his beliefs are. In the case of manifestations of hallucinations and delusions, urgent hospitalization of the patient is necessary, since it is very important to identify the cause of psychosis. These symptoms are not unique to schizophrenia and a correct diagnosis will ensure a speedy recovery.
Depersonalization and Derealization
The syndrome is manifested by a violation of the patient’s perception of his own personality, as well as the surrounding reality. The world around him seems unreal to the patient, as in a play or in a dream, and all events seem not to happen to him. At the same time, a person feels that his body is free from his sensations, and he watches himself from the side, and his body seems to be dead. At the same time, disorders of the sense of time, a violation of emotional reactions, can be observed, while a critical attitude to one’s state is most often preserved.
Negative signs of schizophrenia
Negative symptoms appear, as a rule, after the first psychotic episode. The patient’s social activity decreases, reactions slow down, he becomes withdrawn, tends to loneliness. These signs increase over time, become more pronounced, and worsen after each psychotic episode. That is why it is very important to prevent the occurrence of new exacerbations by making timely preventive visits to a specialized medical institution and strictly following the prescribed treatment.
The negative symptoms of schizophrenia are manifested as follows:
- Thinking worsens: the patient loses the ability to absorb the full amount of information.
- Attention decreases: it is difficult for the patient to concentrate his attention on anything, switch between tasks.
- Impoverishment of speech: vocabulary is reduced, the rate of speech is reduced, long pauses in conversation are characteristic, incoherent speech.
- Decreased social activity: the patient becomes passive, his ability to work decreases.
- Loss of interest: the patient shows indifference to what is happening in the world around him,
Negative symptoms impoverish the patient’s life, make it difficult and sometimes impossible to work. It is impossible to get rid of them completely, but it is possible and necessary to stop their progression. To achieve this goal, it is important to choose the right treatment. It should be comprehensive and involve, along with non-drug methods of treatment, drug therapy.
Our clinic uses antipsychotics , highly effective drugs of the latest generation. The dose of the drug is selected individually, using a blood test for the concentration of the drug. This allows you to limit yourself to taking one drug, achieving the maximum effect and, at the same time, reducing the likelihood of side effects.
In addition to drug therapy, we use biophysical methods of treatment . Their use is also aimed at reducing the number of drugs and increasing the effectiveness of treatment. Biophysical therapies show good results in overcoming symptoms such as delusions and hallucinations.
Psychotherapy and psychoeducation are no less effective . These methods help the patient overcome negative emotions, restore lost skills and return to a full normal life. A very important point in psychoeducation is the patient’s awareness of his illness, which helps him to recognize the emerging signs of exacerbation and prevent their development.
Also, when working with negative symptoms, it is very important to build a program of social and labor rehabilitation of the patient, since it is the development of negative symptoms that greatly impairs the adaptive capabilities of a person. Passivity, decreased volitional control and deterioration of cognitive functions lead to isolation and isolation of the patient. It is very important in the course of recovery after a psychotic episode to return a person to their usual way of life and professional activity. To do this, the clinic “Mental Health” uses group therapy, communication training and work to restore household and professional skills.