The first sign of schizophrenia: recognize and stop

Mental ill-being, an endogenous disease of the schizophrenia spectrum, a severe chronic illness leading to a disorder of mental activity - schizophrenia has been known to mankind throughout the history of existence. Despite this, diagnosis remains challenging. Not every psychotherapist is able to recognize the illness. The disease is characterized by significant clinical polymorphism. Schizophrenia changes a person’s behavior - that’s a fact. Worldwide, 1% of people are diagnosed, regardless of gender, race or continent. The rate may be higher due to true morbidity with mild or erased forms, which are not taken into account in official statistics.

Manifestation of symptoms

Schizophrenia symptoms and signs have three types: positive, negative and cognitive. They appear equally in both women and men. Some symptoms may be difficult to recognize as signs of mental illness. They look like laziness, depression, psychosis. If you look in more detail, the state of psychosis is indeed typical for people with this disease. Schizophrenia in women or men manifests itself at different ages. Schizophrenia in men from 15 to 35 years, and in women from 27 to 37 years.

Congenital and acquired factors of manifestation

Congenital factors for the manifestation of schizophrenia include damaged genes of the schizophrenic type, infectious diseases of the mother during pregnancy. Other factors that increase risks: alcohol abuse or drug use before and during pregnancy. The general state of physical and mental health of the parents at the time of the child’s conception and the environmental environment also influence.

Many negative social, everyday and environmental factors influence the process of cell mutation during crossing over. A natural DNA mutation of 1% leads to the evolution of an organism. But aggravating factors increase the chance of pathological mutation of individual chromosome regions. Acquired factors include: domestic physical and mental violence, living in an urban area, loneliness, harassment, poor social adaptability.

Description of positive symptoms

Abnormal judgments and obsessions are noted at this stage. Schizophrenia causes a disorder of this kind against the will of the sick person. He can philosophize too much and conduct meaningless discussions on topics of an immense and global nature. The topic of conversation is often not only devoid of meaning, but also disordered in the style of narration, and there is a constant jumping from topic to topic. Positive signs of schizophrenia in women and men are accompanied by delusional states, motor and thinking disorders, and hallucinations.

Description of negative symptoms

This group includes signs of schizophrenia with deeper emotional disorders. A person loses the ability to enjoy life. He falls into a depressed state or simply tries to protect himself from society. A neutral or bad mood is observed, but in rare cases the opposite manifestation occurs with an increase in mood. People with emotional disorders are not interested in the feelings of others. And they feel much more comfortable spending time alone. Schizophrenia manifests symptoms and signs of a negative type in the aspect of decreased sexual desire, ignoring hygiene rules, as well as alcohol consumption.

Description of cognitive symptoms

Cognitive signs are characterized by impairments in concentration and certain types of memory. A person cannot adequately plan, organize his own life, or make decisions. Schizophrenia exhibits symptoms and signs in the same way in women and men, but they are not always recognized as a medical history. It is possible to understand that these are disorders only with the help of neuropsychological tests. Schizophrenia can disguise symptoms as depression and psychosis. Tests allow you to find the truth.

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A few years before

The first signs of schizophrenia can appear long before the disease develops. They are called outpost syndrome. Few people are able to suspect an insidious disease in them.

Such initial symptoms of schizophrenia appear several years (3–15) before the development of the disease. Characterized by asthenic manifestations, when there is rapid fatigue and the inability to maintain physical and mental activity for a long time. Sleep is disturbed, mood is unstable, self-control is lost, the person does not control his emotions and becomes irritable.

Asthenia is accompanied by apathy - powerlessness, low mood, lack of desire to perform usual actions, indifference to people and current events, decreased emotional background.

Dysphoria is also considered the first delayed symptom of the disease. This is a pathologically low mood, accompanied by irritability, dissatisfaction with one’s life and everything that happens around. There is a pronounced hostility towards other people.

Initially, it seems that such manifestations are a reaction to a certain unfavorable event. But later it becomes clear that they arise on their own.

Aggression, outbursts of anger, and a tendency to commit illegal actions are also inherent in this condition. It happens that dysphoria is accompanied by enthusiasm and elation. The person becomes overly talkative and may develop delusions of grandeur.

Typically, dysphoria lasts from several days to several weeks. Then it passes.

Naturally, the listed signs are nonspecific, and almost no one would think that they are able to predict the development of schizophrenia.

What are the reasons for development

Schizophrenia does not occur due to one factor. We can say unequivocally that the disease is transmitted by heredity. If one of your close relatives has had such a diagnosis, it will most likely pass on to your children. And for this, the gender of the carriers does not matter. Having second-degree relatives (aunts, uncles, cousins, and grandparents) also increases the risk of receiving a diagnosis. In medical practice, identical twins are also monitored, where one of them has mental disorders. The risk for the second is 65%. In addition to the fact that schizophrenia is inherited by close relatives, it is necessary to take into account the influence of other factors. They can provoke a trigger in the body for the development of mental pathology:

• viral infections;
• stressful situations;
• social factors;
• antenatal infections;
• lack of vitamins.

Psychogenetic studies of schizophrenia

The genetic factor in the inheritance of pathology is a violation of the DNA “instructions”.
RNA reads the sequence of nucleic acids during cell formation. If there is a violation in the instructions, then the wrong protein is encoded. This in the embryo of the child leads to improper functioning of systems or organs. The fetus has healthy dominant genes and damaged recessive ones. With each division, the dominant gene is defeated by 1% mutation, leading to a breakdown of the gene. Next, the correct sequence of nucleic acids breaks down. In this case, a recessive gene begins to work, in which a pathological factor could be embedded. A genetic examination of a child reveals a potential risk of developing mental and physical disorders. Timely treatment and prevention help maintain health.

The situation is more complicated when, during the transmission of hereditary information, the pathological gene is dominant. The initial construction of nucleic acids and proteins will be read by RNA as normal. This leads to the occurrence of diseases already in the early stages of a child’s life.

The occurrence of schizophrenia is the result of the presence of certain defects simultaneously in several genes, less often in just one. The greater the number of breakdowns, the greater the chance of schizophrenia, and the more severe its manifestations.

Twin studies

There are two types of twins - monozygotic (identical) and dizygotic (fraternal). Monozygotic twins appear as virtually identical individuals. Therefore, when one child becomes ill, the question arises that the pathology will be found in another child. If a monozygotic twin has schizophrenia, the risk in the second child is 75% if the disease began before age 20. 58% - under 40 years of age. 50% - after 40 years. A high chance of concordance does not provide a 100% chance that both twins will have schizophrenia, at least at the same age.

Dizygotic twins have a slightly lower chance than monozygotic twins: under 20 years of age – 34%; up to 40 years old 27%, after 40 this chance is about 1%. The study suggests that if one of the fraternal twins develops schizophrenia after age 40, the other is more likely not to have it.

The data described above only applies if both children are in the same mental, physical, social and climatic environment.

Study of high-risk groups

Since it is not a single chromosome that is responsible for the manifestation of schizophrenia, but a collection of damaged chromosomes, risk factors are individual in each case.

First of all, you need to pay attention to the prenatal period. Any infectious disease during pregnancy increases the chance of various pathologies in the child. A mother’s healthy lifestyle does not guarantee the birth of a healthy child, but it also does not increase the chance of developing pathology.

Risks related to the social sphere:

• emotional and physical abuse;
• pedagogical ignorance of parents and teachers at school;
• poverty;
• ethnic oppression and other violations.

Separately, it is worth mentioning physical and psychological violence in childhood, which triggers pathology.

Loneliness, disruption of adequate communication with parents and society are other reasons for the development of the disease. But developing schizophrenia sometimes causes loneliness and disruption of adequate socialization.

The following factors increase the development of pathology at an early age:

• Life in an urbanized city.
• Use of psychoactive substances (including alcohol, cigarettes).
• Presence of other mental illnesses.
• Male gender.
• Domestic mental and/or physical violence.

Influence of the male and female lines

There is a complex correlation between pathology in parents and its occurrence in the child. It depends on the gender and state of mental health of the father and mother. So, if one parent has schizophrenia, then the chance of transmitting a dominant gene with pathology to the child is 12%, and a recessive gene is 81%. If both parents are sick, then 46% is the chance of a dominant gene, 100% is a chance of a recessive one.

According to research, a female parent is more likely to inherit schizophrenia to children of both sexes. But the percentage is higher among boys. A male parent with schizophrenia is less likely to pass on schizophrenia. But also among children, boys get sick more often.

This relationship persists even if the parents do not have schizophrenia, but suffer from other mental illnesses. In this case, children are less likely to develop schizophrenia. But thanks to crossing over, during the formation of gametes, DNA sections of the schizophrenic type are damaged.

Chromosome factor

There are difficulties in diagnosing schizophrenia in the prenatal period. The bottom line is that the gene responsible for the pathology is sometimes located in one of nine or in all nine pairs of chromosomes at the same time. Most of these genes are recessive. This means that different triggers are needed for schizophrenia to occur.

The following chromosomes sometimes contain a disease-promoting gene:

• 1st pair, 2 telomeres 1p21.3, 1p36.1;
• 2nd pair, 3 telomeres 2p15.1, 2q32.1, 2q32.3;
• 6th pair, 2 telomeres 6p21.3-p22.1, 6p22.3;
• 8th pair, 3 telomeres 8p23-p21, 8p23.2, 8q21.3;
• 10th pair, 1 telomere 10q23.32;
• 11th pair, 4 telomeres 11q24.2, 11p15.3-p14, 11p15p5, 11q23;
• 12th pair, 1 telomere 12p12;
• 16th pair, 1 telomere 16q22.2;
• 18th pair, 1 telomere 18q21.2.

Chromosomes consist of telomeres, which they change during crossing over, which leads to natural mutation of the organism. Each telomere has its own region that determines one or more functions. So, let’s say the gene on the 11th pair of chromosomes 11p15.5 is responsible for the dopamine receptor D4. Disruption of this receptor leads to poor dopamine production in humans. Failure of the full functioning of the dopamine receptor leads to frequent depression, apathy, suicidal thoughts, and drug addiction.

Diagnosing the DNA structure during pregnancy helps to properly prepare parents for the difficulties that the child will face. In the future, with the widespread use of genetic engineering, damaged genes will be correctable. Conducting DNA analysis in adulthood facilitates complex psychiatric and drug treatment.

With the help of genetics, information is obtained about concomitant pathologies in the body that occur in parallel with schizophrenia.

Risk factors and complications

Signs of schizophrenia in men and women at different stages may not appear or periodically disappear. This is especially possible if treatment is followed. There are patients who lead normal professional and social lives, although this diagnosis is characterized by a desire to isolate themselves from society. Schizophrenia develops gradually in women and men over several years. Risk factors include the following conditions:

• suicide attempts (5-6% of patients commit suicide);
• alcohol abuse;
• outbursts of aggression;
• addiction.

Changes in behavior and habits

Among the external signs of schizophrenia that indicate its onset, the first to be distinguished are strange behavior. The patient withdraws into himself and withdraws from people. Can sit for hours in a closed room and lie on the bed. Signs of apathy are growing. Stereotype of movements increases.

One of the pathognomonic symptoms at the dawn of schizophrenia is paragnomena. This is a discouraging, unexpected behavior of the patient that is not typical in the normal state. For example, he cuts all his clothes into small pieces, arguing that this way he can put them in his closet more compactly.

The patient seems to go with the flow, submitting to all life circumstances, does not try to improve his existence, does not strive for achievements, to realize his plans.

A typical, characteristic sign of schizophrenia at an early stage is loss of interest in previously significant interests and hobbies. For example, a person used to be fond of cycling and rode a bicycle for several hours almost every day. Perhaps he took part in competitions. And then abruptly, for no apparent reason, he abandoned what he loved, settled at home, and isolated himself.

But he develops new passions. A fascination with the supernatural and metaphysical becomes typical. Often the subject of interest for patients is psychology, philosophy, mysticism, even if previously he was not interested in these areas at all. But most often, patients begin to get involved in religion. Scientists attribute this to the whimsicality and inconsistency of religious images and paintings, which reject and question the generally accepted norms of development of the world around us. Subsequently, these images become the subject of delusional ideas and hallucinations.

A person stops caring about anything at all. He even stops performing basic hygiene procedures: brushing his teeth, washing himself, and becomes unkempt and sloppy. His clothes are dirty, his hair is disheveled, but he doesn’t care what he looks like.

In another case, he spends an unusually long time on water procedures. For example, patients are able to spend several hours in the shower.

Strange cravings appear. The patient can go to a landfill, collect garbage and bring it home, accumulating mountains of unnecessary trash there. There may be a craving for theft and arson. But there are also pleasant changes: patients delve deeper into reading. But this is also pathological in nature, since they tend to read everything that catches their eye.

They forget about food and are able to go without food for several days. Or they come up with fancy diets, or they prefer to eat only one specific product.

Body dysmorphic disorder is a symptom that is a manifestation of many mental disorders. Including schizophrenia. A person becomes convinced that some part of the body is deformed. Too big nose, thick legs, protruding ears. In fact, these organs do not bring any resonance to his appearance.

The patient can hide his concern or, conversely, tell others, use any means to hide the “flaw”. His fixation can be detected when he stands for hours near the mirror, looking for poses in which his “flaw” is not so noticeable. He refuses to be photographed and hides his photos from others. This distorted self-perception sometimes leads to suicide attempts. That is, the patient cannot tolerate his imaginary deficiency to such an extent that he is unable to exist with it.

In general, a person is isolated from society, withdraws into himself, becomes greedy with emotions and strange in behavior.

These signs of the disease are often ignored. Or such people cause resentment among loved ones, bewilderment and irritability among other people. As a rule, people consult a doctor only in cases when the symptoms begin to blossom and hallucinations and delusions appear in the arena.

All early symptoms of schizophrenia are characterized by incompleteness, vagueness and episodicity. This causes difficulties in making a diagnosis, confusing doctors. Therefore, they are in no hurry to issue a final conclusion until typical signs appear.

Although many patients are absolutely sure that they are healthy, there are also those who imply that something is happening to them. They study information about their mental state, eventually finding a rationale for it, and are even able to make the correct diagnosis for themselves.

This is how one young man describes his medical history. It started around age 25. At first it was a pathological fixation on the mistake. If he heard a word that sounded wrong to him, he began to repeat other words starting with that letter. This allowed him to relieve tension. For a while, such a ritual even brought pleasure.

In another case, an unpleasant event, for example, a broken cup, caused him to create a sequence in his thoughts, a sequence of reverse actions: from a negative result to the beginning of the event. It also brought him joy and relieved his anxiety for a while. But if something interrupted his thoughts, he had to start again.

Each time it seemed that it would end soon. But as soon as any incident happened, everything would repeat itself. It happened that, while composing his chains, he spent 20 hours in bed or walked around the room.

Soon voices appeared, whispering unpleasant thoughts. They were so obvious that the patient felt as if they were his own. Then the sounds around me intensified. We had to wear headphones because they really irritated our hero. It happened like this: a car passed by, and he looked at it with a different look. Then you had to look again, right. There was a fear that the car would drive away and he would not complete his ritual.

During this time, he repeatedly consulted doctors until, finally, a diagnosis was made and the correct treatment was prescribed.

Main types of disease

In the medical classification, the main types of schizophrenia include 9 positions. Some of them have subtypes. Experts identify several of them, which occur most often. Paranoid schizophrenia manifests itself in increased suspicion of others. A person is haunted by the feeling that he is constantly being watched, he has delusions and hallucinations. In the catatonic form of the disease there are movement disorders. And this can be either complete immobilization or chaotic disorderly excitement. Simple schizophrenia does not have a history of acute psychosis, but negative symptoms increase over time. The hebephrenic form manifests itself in the form of dementia and foolishness.

Main signs (criteria) of schizophrenia

The diagnosis is made based on the international classification of diseases (ICD-10). Schizophrenia is presented in section F20. Main criteria:

1. Openness of thoughts - someone puts them in or takes them away, others know what a person is thinking about.
2. Ideas of influence - a person is sure that someone controls his thoughts, actions, body movements, he is in the power of secret services, aliens or sorcerers.
3. “Voices” in the head or body that comment and discuss a person’s behavior.
4. Other ridiculous ideas include being able to control the weather or communicate with otherworldly forces, or being related to famous political or religious figures. The content of these ideas may vary depending on a person's beliefs and events in society.

Diagnosing hallucinations in schizophrenia is not always easy. The patient sometimes does not realize that these are manifestations of the disease and does not tell anyone about them.

Important

Hallucinations in schizophrenia often occur inside the head or body - these are “voices”, the insertion or withdrawal of thoughts, unusual burning sensations, tingling sensations.

Headache in schizophrenia is often accompanied by a feeling of influence from the outside - it is caused by ill-wishers or alien beings, using complex technologies (laser, radiation) or witchcraft:

• burning in the head;
• feeling of bursting from the inside;
• feeling of squeezing of the head;
• difficulty thinking;
• a feeling of heaviness in the temples and the back of the head.

Weakness in schizophrenia can be a manifestation of exhaustion of the nervous system during or after an attack, or it can accompany the disease constantly and go away only with adequate treatment with antipsychotics.

Sleep disturbances in patients with schizophrenia may indicate the onset of an exacerbation. Sleep becomes restless, unproductive, and daytime sleepiness plagues you. This problem is especially troubling for patients with comorbid depression and anxiety. Diagnosis of insomnia in schizophrenia is carried out by an experienced psychiatrist.

Diagnostics

At different stages, schizophrenia manifests symptoms in a range of emotions from baby talk and delusions with hallucinations to suicide attempts. It is necessary to conduct a medical examination to determine the exact clinical picture. Anamnesis is collected based on detailed questions about the patient and his relatives. The doctor will conduct a test for schizophrenia to determine the diagnosis. We are talking about a neurotest that shows immune blood parameters. Based on them, a decision is made on the final diagnosis and its severity. If necessary, the patient may be prescribed an MRI of the brain. Correctly selected treatment for schizophrenia has good results. In 50% it is possible to achieve remission, and 25% of patients completely get rid of the diagnosis, provided that the forms of schizophrenia can be corrected.

Classification

Continuous schizophrenia often begins at an early age.
She is progressing quickly. Without treatment, it leads to disability within 4-5 years, there are no remissions. Patients show an extreme degree of apathy, their speech is monotonous. Hallucinations are predominantly of a fantastic nature. The pathology is characterized by apathetic-abulic symptoms, dementia, and delusional ideas. Malignant juvenile types of the disease are more common in boys. During the period of manifestation, bright lucid catatonia is noted. This is a state of stupor in which consciousness is almost not disturbed. The memory is preserved. Oneiric catatonia occurs with equal frequency - stupor with disturbance (clouding) of consciousness and memory loss.

The paranoid type during the period of exacerbation is characterized by the predominance of delusional ideas of persecution. Occurs more often in women in adulthood. In addition to delusions, there are illusions and hallucinations of a threatening nature. The mood is often optimistic, but during attacks anxiety and depression predominate.

The recurrent type of course (periodic) is characterized by pronounced somatic disorders. Tachycardia, dehydration, and hemorrhage are present. Patients are able to maintain their ability to work, but personality disorders are noticeable. During the development of the disease, long intervals without symptoms are observed. During attacks, symptoms differ in affective overtones (depression or mania). Possible oneiroid stupefaction, catatonia.

Paroxysmal-progressive schizophrenia includes:

• rough progression - clear periods of remission with a complete absence of symptoms;
• medium - during the period of remission, symptoms do not go away completely;
• small - remission intervals do not have clear boundaries.

Personality changes in paroxysmal schizophrenia occur only during exacerbations and attacks. An exacerbation is characterized by acute delirium, insomnia, and severe anxiety. The fear of going crazy prevails.

Schizotypal disorder is a sluggish course of schizophrenia. During exacerbations, inappropriate behavior, isolation, sluggish emotional reactions, and eccentricity predominate. Thinking and speech are unique. Psychopathological symptoms are weak.

Atypical prolonged pubertal seizures

Schizophrenia in the form of an atypical prolonged pubertal attack, often with a benign course. Symptoms: body dysmorphic disorder, asthenia, infantilism of behavior and thinking.

People aged 11 to 23 years are at risk. This type of disease includes crisis manifestations of adolescence, which are distorted and their clarity increases. The stages of pathology are similar to the stages of adolescence:

1. Initial manifestations are typical for patients aged 11-15 years. Characteristic traits become sharper, and bipolar affective disorders arise. Characterized by opposition to the surrounding world, an excessive need for self-affirmation. There is a high level of conflict, ideas of an overvalued nature.
2. The increase in psychotic symptoms occurs between the ages of 16 and 20 years. Seizures occur, accompanied by onirism - delirium with hallucinations and confused consciousness. Problems with the associative process and ideas of guilt are noticeable. In addition to hallucinations, there are insomnias. At this stage, the person needs hospitalization and immediate initiation of therapy.
3. At 20-25 years of age, symptoms become dynamic, and “bright” periods of remission appear. Social and labor adaptation is being restored.

Schizophrenia in the form of an atypical prolonged pubertal attack is formed on the basis of constitutional genetic factors. Primary importance is given to the mechanisms of adolescent maturation. While analyzing the family background of the patients, scientists came to the following conclusion. The family history of persons with atypical schizophrenia includes sluggish and paroxysmal forms of schizophrenia in the parents.

There are 3 types of atypical pubertal seizures. The first type is heboid attacks. They are characterized by exaggeration and modification of the manifestations of the teenage crisis. Volitional and affective disorders predominate. They lead to disregard for generally accepted norms of behavior. Stages of heboid type:

1. At the initial stage, patients are from 11 to 15 years old. They experience increased excitability, perverted emotional reactions and desires. The attitude towards the surrounding world is skeptical and cynical. There is a noticeable desire for originality in reasoning. There are no common interests with peers. Dysthymia, dissatisfaction with oneself, predominates. Patients spend their time wandering the streets or idle.
2. At 15-17 years old, the second stage of the disease begins. Pubertal disorders are characterized by psychopathic-like symptoms. The patients are rude, inadequate, and there is no motivation for activity. Negativity towards social norms is clearly manifested. Patients are eccentric, hostile towards relatives and strangers. The attacks are accompanied by impulsiveness, unreasonable rage, and aggression. Intellect is relatively preserved, but academic performance is poor. There are affective disorders, delusions, and hallucinations are possible.
3. At the third stage (at 17-20 years old), symptoms stabilize and slow down at the second level. The clinical picture is monotonous and does not change against the background of changes in external conditions. There is an independent improvement in the condition without medical intervention. It lasts from 2-3 days to 2-3 weeks. But then it gets worse again.
4. At the fourth stage, behavioral disorders are smoothed out, unmotivated hostility towards parents subsides. The stage indicates stable remission.

Starting from stage 2-3, patients with heboid attacks often begin to use psychoactive substances. Such a person is not amenable to correction or drug treatment. When taking psychoactive substances, mental retardation progresses. Teenagers with this pathology mature very slowly. At stage 2-3 of the disease, the process of growing up practically stops.

The second type of atypical schizophrenia is dysmorphophobic and psychasthenic-like disorders. Patients are dominated by the idea of ​​an illusory physical defect in appearance and body structure. General clinical picture:

• asthenia;
• previously unusual indecision, uncertainty;
• problems in socialization;
• constraint in communication;
• tendency to “soul-searching” and reflection;
• derealization, depersonalization.

A large number of phobias and unreasonable fears develop. On the affective side, the bipolar current predominates. A person hides illusory flaws in appearance with clothes and shoes. Fear - hearing condemnation addressed to you. Stages of development by age with symptoms:

• Initial stage - the patient is from 15 to 18 years old. There is anxiety about excess weight. The patient is concerned about the “irregular” shapes of various parts of the body, the presence of birthmarks, etc. Persistent ideas about one's own defects interfere with learning or work. The person becomes withdrawn. He does not visit public places, does not communicate. There is an affective reaction to what is happening, colored by symptoms of hysteria. The presence of verbal illusions and paranoid thoughts about non-existent “bullying” is noted. Expressed hypochondria, a tendency to self-digging, asthenia.
• The second stage (22-23 years) - beliefs about defectiveness are smoothed out, the affective component is less pronounced.
• The third stage (24-26 years) - symptoms include affective disorders and inadequate ways of responding. What remains is isolation, excessive suggestibility, and self-centeredness.

Youthful metaphysical intoxication is a condition characterized by pretentious mental activity. Symptoms: blurred thinking, slipping, reasoning. Patients are “out of touch” with reality, their reasoning is unproductive. Characterized by fantasizing and isolation similar to autism. Other manifestations: fears, depersonalization, emotional scarcity, depression.

Paranoid schizophrenia

Another type of disease is chronic delusional psychosis or paranoid schizophrenia. This is a disorder in which delusions become the leading symptom. Unlike other types of disorder, delusion is not dynamic and stable. Delusional ideas are systematized.

Ideas about persecution and jealousy dominate in thinking. Hypochondria is very noticeable. There are no gross violations of personality traits. The emotional-volitional sphere is characterized by impoverishment. A special place is occupied by delusional psychosis of the dysmorphophobic type. Such patients are falsely convinced of the presence of physical defects that disfigure their appearance.

Pathology often affects young and mature people. Dysmorphophobia is more common in the female sex. Existing methods of therapy are ineffective against persistent delusional beliefs. Medication and psychotherapeutic approaches accomplish the task of reducing affective disorders. Most patients are able to maintain their ability to work, study and work for a long period.

Researchers have described the dynamics of paranoid manifestations. It develops in accordance with 3 directions: “migration, protection, attack” (“pursued pursuers”). The patient tries to escape from recruitment or persecution. At this time, he changes his place of work or residence. But even in a new location he again notices an attacker who wants to harm him. The patient begins to fear health risks and considers precautionary measures. He buys weapons and does not leave the apartment. If there are false beliefs about poisoning, all food in the refrigerator is carefully checked. To protect themselves, patients often turn to the police.

Chronic paranoid psychosis, occurring with phenomena of overvalued delusions, is another type of paranoid schizophrenia. The pathology most often affects adolescents or young adults (up to 21 years of age). The development of psychosis is slow. Highly valuable ideas often manifest themselves in research activities that were previously unusual for humans. These can also be extremely valuable ideas in love and collecting.

The manifestation of the disease is associated with psychogenic trauma, which becomes key among the patient’s experiences. Psychosis is characterized by periods of exacerbation, attenuation and reverse development of delusional beliefs. The “attenuation” stage can last from 3 to 10 years - the affective intensity of delirium decreases. Then the symptoms reverse.

Residual states (residual effects of pathology) do not always occur in paranoid psychosis. Statistics indicate the following. In people suffering from psychosis for more than 20 years, only 22% of cases developed residual conditions.

Special forms

Febrile schizophrenia is a special type of pathology that includes symptoms of severe toxicosis. Symptoms: severe increase in body temperature, oneiric disturbance of consciousness, overexcitation. There is a cycle of exacerbations and remissions. During the period of remission, symptoms completely subside.

Mosaic is another special type of pathology. Symptoms: increased temper, paranoia, a tendency to complain about imaginary problems, inflated self-esteem to the point of delusions of grandeur, a tendency to manipulate, problems with social adaptation. The symptoms are not persistent and varied. The essence of pathology is that a person experiences a “mixing” of different psychotypes. Therefore, specific symptoms are difficult to describe. At one time a person is characterized by aggressiveness and rudeness, at another - curiosity and tolerance.

There is social schizophrenia, in which a person tends to ignore the discrepancy between personal conclusions and actions. The physiology of the brain is not affected. Symptoms are long-lasting and remissions are rare.

Brief description of other types of pathology:

• Regular schizophrenia is a dissociative disorder caused by stress. With pathology, a person’s personality acquires characteristics that are opposite to each other. There are practically no remissions.
• Circular is a pathology that is more common in middle-aged people. Symptoms include manic and depressive phases, combined with hallucinations and delusions. Emotionality is poor.
• Hypochondriacal - excessive concern about one's own health. Unusual, disturbing sensations arise in the body. Neurosis-like symptoms are present.
• Senestopathic - uncomfortable bodily sensations. They can be localized both externally and on internal organs. The sensations arise without external triggers, and no objective causes are found in somatic health problems.
• Autumn schizophrenia is a pathology that worsens in the fall. Symptoms of depression dominate. Remissions occur at other times of the year.
• Resistant - a stable form of the disorder. It cannot be corrected by psychopharmacology. Remission is possible after treatment with two antipsychotic drugs for 5-8 weeks. Exacerbations are frequent.

Treatment

The first signs of schizophrenia are the ideal time to start therapy. In most cases, this does not work out because the symptoms are ignored or mistaken for other pathological conditions. If the test for schizophrenia confirms the diagnosis, the doctor will prescribe appropriate treatment. If acute symptoms occur, drug correction is recommended. This mainly applies to the following conditions: depression, anxiety, sleep problems, severe apathy, thinking disorders. Schizophrenia in men and women, if the treatment plan is followed, has a positive prognosis. For this purpose, psychotherapy is also used and social rehabilitation is carried out. In the process of treatment, it is necessary to ensure that the signs of schizophrenia in the negative group decrease in severity. In the future, it is important to maintain the condition to avoid relapses.

PsyAndNeuro.ru

Ideas about the genetic nature of schizophrenia have been debated for more than a century. Back in 1919, Kraepelin suggested a “hereditary predisposition” to the occurrence of schizophrenia: “I know of a fairly large number of cases in which siblings were simultaneously affected by dementia praecox.” However, the great psychiatrist also suggested other options for the etiology of schizophrenia, including “infections during the years of development of the body.” In the 1960s in the United States, the genetic theory of the etiology of schizophrenia was listed in textbooks along with psychoanalytic and other psychological theories. It has been argued that “the understanding of the relative role of genetic factors is still far from clear.” However, by the end of the 20th century, schizophrenia was perceived as “certainly a genetic disease...with an inherited risk of 80%-85%.” Some geneticists have even argued that "there is a strong likelihood that all or almost all cases of departure from direct genetic dependence can be explained by non-heritable changes in genetic structure or expression." In other words, according to those researchers, schizophrenia may be a 100% genetic disease, in the occurrence of which the role of environmental factors is minimal or absent.

By 2003, the Human Genome Project also ended, and there was no end to the optimistic expectations of researchers. It was expected that, using genetic analysis methods, the notorious “schizophrenia genes” would be discovered in the very near future. And by identifying these genes, it will be possible to fully understand the pathogenetic mechanisms and develop a new generation of highly effective drugs for the treatment of this disease. Such prospects inspired unprecedented optimism among researchers. Large-scale studies of more than 800 possible genes have been initiated, with more than $250 million in funding. However, the results were, to put it mildly, far from expected: “although the studies showed some clear results, other studies examining the role of the same polymorphisms found conflicting data.” Then the researchers conducted narrowly focused studies, with 25 and 86 genes, respectively, but even there “there was insufficient evidence indicating that the main polymorphisms of these genes are more associated with schizophrenia than polymorphisms of genes from the control panel, whose association with schizophrenia is not was supposed." Such discouraging results have led many scientists, in the words of geneticist Sullivan, to “abandon the genetic theory ... because it has only led us in the wrong direction, due to which much effort has been wasted.”

A small glimmer of hope has emerged with the rise of genome-wide association studies (GWAS). In the USA, the National Institute of Mental Health began to allocate more than $100 million a year for genome-wide research into schizophrenia. However, despite sampling data from more than 170,000 people obtained through the Psychiatric Genomics Consortium, the results were rather modest. It turned out that the number of identified polymorphisms with a possible association with schizophrenia exceeded 1500, and in the general population they occurred so often that their use for predictive purposes made virtually no sense. The correlation of the overall polygenic risk value with specific genes or sets of genes did not exceed the level of statistical error. Further complicating matters, many of the so-called “schizophrenia risk genes” have been linked to other psychiatric conditions, including bipolar disorder, depression, and even attention deficit hyperactivity disorder.

All this led, as Gershon et al. put it, to “disappointment in the air” among psychiatric geneticists. As geneticist Leo puts it, “The current trend in psychiatric genetics is to use huge samples to find genes with tiny effects.” The absence of any practically significant results from the colossal genetic studies of schizophrenia, which lasted throughout the first decade and a half of the 21st century, was regarded by some as one of the extremely painful defeats of modern science. Science journalist Wade caustically called the situation “the Pearl Harbor of schizophrenia research.” It's probably time to step back and rethink all the steps that led us to all this.

Inherited theories of the etiology of schizophrenia are based on family studies, studies of families with adopted children, and especially twin studies. Most calculations of hereditary risk scores have been based on the difference between concordance of schizophrenia between dizygotic (DZ) and monozygotic (MZ) twins. It is important to first understand these twin studies in order to understand why such high rates of hereditary risk have led to the widespread idea of ​​schizophrenia as a predominantly genetic disease.

Back in 1961, Rosenthal published a now classic paper on the limitations of the twin method in schizophrenia research. Subsequently, other researchers confirmed his observations: if twin pairs were not confirmed in population registries, if there were errors in determining zygosity, if rather broad diagnostic criteria were used, the concordance rate in MZ was artificially increased. Other scientists have also noted that twins may not be representative of the general population because, compared with other people, they have a higher risk of birth injuries, lower birth weight and higher mortality. Thus, “schizophrenia may be concordant on the basis of birth trauma as much as on the basis of genetic predisposition.”

Another fundamental problem with twin studies is the underlying assumption that common external factors affect both twins from both MZ and DZ pairs in the same way. However, it is known that in about 15% of cases, one monozygotic twin receives more blood than the other (a condition called feto-fetal transfusion syndrome). Consequently, monozygotic twins are unequally exposed to hormones, drugs and infectious agents from the mother's blood. A similar phenomenon is not observed in DZ twins. In addition, twin studies assume that both MZ and DZ have the same social environment. However, numerous psychological studies have shown that MZ, but not DZ twins, spend more time together and form similar social bonds.

Another problem is that in twin studies, the influence of genes and the environment is assessed as independent forces that do not interact with each other. However, it is now known about the existence of gene-external environment interactions that occur in many diseases, including schizophrenia.

Most twin studies of schizophrenia have used special samples that are not representative of the general population. Only 6 studies from Scandinavian countries used nationwide twin registries. Taking their results together, pairwise concordance for schizophrenia in MZ twins is 28%, and for DZ twins – 6%. In addition, most twin studies did not use pairwise concordance*, but probandwise concordance; read more about the differences in methods for calculating concordance here. When calculating it, pairs in which both twins suffer from the disease are often counted 2 times (since the variable in the calculation formula is not the number of pairs of sick twins, but simply the number of sick individuals, which is then multiplied by 2), which increases the concordance rate, based on from which the hereditary risk indicator is also calculated.

To clearly demonstrate the problematic nature of twin studies, let us turn to the latest work to date, written by Hilker et al. Among MZ twins, only 12 out of 81 pairs (15%) had both twins suffering from schizophrenia. However, because the twins of some of these pairs were assessed separately, proband-by-proband concordance was determined by the authors to be 33%. This finding served as a starting point for constructing structural equations and threshold models of genetic risk, as in other twin studies of schizophrenia. The authors were aware that constructing such models implies that “twins are representative of the population,” that “both MZ and DZ twins are equally influenced by their environment,” and that “gene-environment interactions » are minimal. And as stated earlier, such assumptions were found to be incorrect. In the same study, the authors then report that the hereditary risk of schizophrenia in their data is 79%. There is clearly something fundamentally wrong with a modeling technique that produces hereditary risk values ​​of 79% of 15% concordance among MZ twins. And yet, it was precisely on such calculations that theories about the genetic etiology of schizophrenia were originally based.

Although most estimates of hereditary risk for schizophrenia have relied on data from twin studies, some work has relied on family studies. Authors from Sweden and Denmark used national medical databases to determine how often children of people with schizophrenia have the same diagnosis. Based on these data, hereditary risk values ​​of 64% in Sweden and 67% in Denmark were obtained. Researchers from Taiwan did a similar thing, but according to their data, the “heredity” of schizophrenia is determined by genetic factors only by 47%, and by 53% is determined by similar and different external factors.

We assume that schizophrenia, like almost all human diseases, certainly has some genetic background. We only question the view of schizophrenia as a predominantly genetic disease. Perhaps the “missing hereditary component” that arose during the transition from classical genetic to molecular genetic methods can be explained by the assumption that certain environmental factors may be built into the etiological structure of schizophrenia, which manifest themselves in the same way as genetic factors, but in essence they are not, which makes schizophrenia a “pseudogenetic” disease in its manifestations. We illustrate this with two examples: an infectious agent and a microbiome.

Toxoplasma gondii

may serve as an example of how the above hypothesis works.
T. gondii
is a widespread protozoan parasite that causes toxoplasmosis in its primary hosts, felines.
However, a large number of other mammals can be carriers of Toxoplasma. When a domestic cat becomes infected with this parasite, it sheds up to 50 million extremely tenacious T. gondii
. It is not known for certain how many oocysts are needed to infect a person, but, for example, pigs comparable in size to humans only need one.

Toxoplasmosis, like schizophrenia, runs in families, especially in families with domestic cats. Family members may eat the same contaminated food or use the same contaminated water source. Children can often become infected by playing in sand or soil contaminated with oocysts from cat feces. Like schizophrenia, Toxoplasma carriage can be transmitted from mother to child. Cases of vertical transmission have been documented, even if the mother was infected up to the 5th month before conception. During experiments on laboratory mice, it was shown that the offspring of one infected female, up to the 10th generation, were also carriers of Toxoplasma.

Regarding toxoplasmosis in twins, it has been shown that in the case of intrauterine infection, both MZ twins become carriers in 19 out of 20 cases. If infection occurs in childhood, carrier concordance is significantly lower.

The association between toxoplasmosis and schizophrenia has been shown in more than one meta-analysis. It has been reliably established that carriers of Toxoplasma have a 1.8-2.7 times greater risk of developing schizophrenia than the general population. No GWAS for schizophrenia has been able to produce similar results. In the United States, increased individual exposure to Toxoplasma has been partially associated with first episode psychosis, but not with established schizophrenia, which may be explained by the antiprotozoal properties of some antipsychotics. Moreover, one prospective study from Denmark found that shortly before the onset of psychotic and other psychiatric symptoms, a significant proportion of patients showed higher Toxoplasma seropositivity. Thus, the greater risk of T. gondii infection cannot be attributed to hospitalization or other similar events.

Therefore, if we take for granted the influence of T. gondii on a certain proportion of emerging cases of schizophrenia, the clinical and anamnestic picture will look as if we are dealing with a genetic disease. This does not mean that genes do not play any role in this process. On the contrary, the influence of polymorphisms of genes of components of the major histocompatibility complex on resistance to Toxoplasma infection has been known for many years. Interestingly, these genes showed some of the strongest associations in GWAS of schizophrenia. In addition, a study published this year showed a significant proportion of common polymorphisms associated with both the risk of Toxoplasma infection and the risk of developing schizophrenia.

Another source of “pseudogenetic” associations in schizophrenia is the human microbiome – a set of microorganisms located on the mucous membranes. The microbiome is largely inherited from the mother during and after birth, although other family members who come into contact with the child in the first months and years of life also contribute to its formation. The results of twin studies suggest a role for genetic factors, probably genetically determined characteristics of the immune system and receptors for the microbiota. However, it is shared environmental factors, rather than shared genes, that largely determine the family similarity of microbiomes.

Features of the microbiome have been shown to influence behavioral and cognitive traits in both animals and humans through a complex set of interactions, referred to for simplicity as the gut-brain-immune axis. With regard to schizophrenia, some studies have found marked changes in the microbiological composition of the gastrointestinal and oropharyngeal microbiota in individuals with schizophrenia compared to healthy subjects. In addition, an association has been established between the use of antibiotics in early life and the risk of developing schizophrenia in later years. Of course, there is also evidence that many antipsychotics themselves cause changes in the microbiome, but recent work has found that even in patients with a first episode of psychosis, the microbiome is already altered, although the role of drug therapy in this seems to be minimal. All this may indicate that changes in the microbiome may be one of the risk factors for the development of schizophrenia.

The bottom line is that schizophrenia may be a disease in the etiology of which external factors, infectious or otherwise, play a major role, but it is genetic factors that determine the degree of susceptibility to these factors. The hereditary risk in this case will be about 30%, but not 80%.

If we have indeed overestimated the role of genetic factors in the development of schizophrenia, then the failure of attempts to identify genes sufficiently associated with schizophrenia can be explained. There is also an explanation for the genetic paradox that lies in the persistence of schizophrenia in the population despite the very low birth rate of children from those suffering from it. From the beginning of the 19th century until the mid-20th century, patients with schizophrenia were kept in closed institutions, where the birth of children was an extreme rarity. But even after this, the fertility rates of people suffering from schizophrenia were at most one third of those in the general population.

Huge sums and resources have been spent on large-scale genetic research, while other promising areas of research, such as neuroinflammation, infectious agents, the microbiome, and others, have been grossly underfunded. Because of this, we probably lost a lot of time and indefinitely delayed the emergence of new, truly promising drugs for the treatment of schizophrenia. But it is the development of new, highly effective therapy that is, in fact, the point of application and the ultimate goal of fundamental research. We should try to move away from sterile, narrow genetic studies towards studies that study the influence of both genes and the environment and their interactions, and then perhaps we will have a chance to catch up.

Author of the translation: Kibitov A.A.

Source: Torrey EF, Yolken RH. Schizophrenia as a pseudogenetic disease: A call for more geneenvironmental studies. Psychiatry Res. 2019 Aug;278:146-150. doi:10.1016/j.psychres.2019.06.006. Epub 2019 Jun 4.

Myths and misconceptions

Behavior reveals signs of schizophrenia openly if you understand the specific manifestations of the disease. People with this diagnosis are considered non-violent and safe for society. This is not a myth, but we must take into account possible outbursts of rage and aggression, and unpredictable actions.

Personal failure and stupid behavior - this is also what others often say. Yes, certain stages of schizophrenia lead to this condition. A person can even behave like a child. There are forms of schizophrenia with not very pronounced symptoms. People in such cases are no more stupid than others in society. It is interesting that among people diagnosed with schizophrenia, there are many talented artists and musicians. A striking example is Vincent Van Gogh.

Depression, bipolar, schizophrenia: a guide to mental disorders

Relationships with “border guards” are always difficult: they are extremely emotional and impulsive, and a few random words may be enough for the partner to turn from a savior into an enemy in their eyes. And in anger, people with borderline disorder can be terrible both for others, attacking them with abuse or even fists, and, above all, for themselves: almost everyone has, if not attempted suicide, then seriously self-harmed.

The origins of the disease usually lie in childhood, in a lack of parental attention and support. And this is not necessarily direct violence: if the mother often leaves the baby alone and does not react to his crying, he learns that the attention of others must be won through battle.

The disorder is considered treatable. Cognitive-behavioral psychotherapy has proven itself best, as it provides skills in understanding and controlling one’s emotions.

Narcissism

Hundreds of books have been written about narcissism, and it is seen as the cause of many bad actions, but in itself it is not a mental disorder. Narcissistic traits are common to most people, and they are what make us ambitious and push us to climb the career ladder. The diagnosis of narcissistic personality disorder (NPD) is made quite rarely when an obsession with external success makes a normal social life impossible.

In the American Manual of Mental Disorders, NPD is characterized by grandiosity (in fantasy or behavior), a constant need for admiration, and a lack of empathy that begins in adolescence and affects all areas of life. There is no such disorder in the classification adopted in Russia, perhaps due to distrust of psychoanalysis, on which the very concept of narcissism is based.

Narcissists spend all their energy in the struggle for recognition, but this desire for perfection is caused by far from positive experiences: a person creates an impeccable external image, because he is endlessly ashamed of his real self. An inflated ego is designed to protect a very vulnerable personality. In an effort to meet society's expectations, the narcissist ceases to understand what he is like and what he really wants, which often leads to depression.

There is no cure for narcissism, as psychotherapy has proven to be effective. The problem is that the patient is afraid to admit imperfection even to himself, not to mention an unfamiliar psychologist. However, a person can consciously strive to protect the feelings of loved ones and not increase his self-esteem at their expense.

ADHD

Attention deficit hyperactivity disorder (ADHD) is increasingly heard in schools: it affects up to 10% of children, and it greatly complicates the educational process. Such guys are noisy, impulsive, disobedient, they cannot concentrate on tasks and sit calmly at their desk. The criteria for ADHD are quite vague, which is why it is called a syndrome and not a full-fledged disease. ADHD is often attributed to completely normal childhood restlessness or lack of upbringing.

Ways to prevent disease

Schizophrenia provokes a disorder of normal life not only in the person diagnosed, but also in his family and close people. The disease is inherited, so prevention is aimed at leveling this aspect. It is necessary to reduce the risk of stress, maintain hormonal balance, not drink alcohol, and not take drugs. All possible risk factors must be addressed for the diagnosis of schizophrenia to become a reality. It is recommended to do things that help stabilize the psyche: physical labor, drawing and other manual creativity. It is better to understand the risks and carry out prevention than to then undergo treatment for schizophrenia.

How to make an appointment with a psychiatrist at JSC “Medicine” (clinic of academician Roitberg)

Anyone who has been diagnosed with schizophrenia needs psychological help. This is a normal human need to strive to return to normal life. Our clinic treats the delicate problems of patients with understanding. At the appointment, a psychiatrist will help you understand the essence of schizophrenia, find a way out of the situation and support you on the path to recovery.

You can make an appointment with a doctor on the website using a special form or by calling +7 (495) 775-73-60. The clinic is located within walking distance from the Mayakovskaya metro station in the center of Moscow: 2nd Tverskoy-Yamskaya lane, 10.