On the verge of two worlds: how people with schizophrenia live and feel

Publication date: November 6, 2020

Schizophrenia is a serious mental illness that has a long, chronic course. With this pathology, specific personality changes occur. In particular, it is characterized by a splitting of emotions, thinking and other mental functions. The disease, as a rule, debuts in young and even teenage years, but in some cases the first clinical signs are detected in people over 40 years of age. Treatment of fears in schizophrenia is one of the most important tasks of a psychiatrist.

Please note: In men, the pathology manifests itself earlier, and the prognosis is less favorable than in women.

The outcome of the disease may be different. Some patients develop subtle personality changes that have virtually no effect on adaptation in society. Others may have deep defects that make it impossible for the patient to be outside the clinic.

Symptoms of schizophrenia

Patients with schizophrenia exhibit a number of fairly characteristic symptoms.

Clinical manifestations of schizophrenia are:

• decreased emotional response;
• apathy;
• disordered thinking;
• obsessions;
• hallucinations (in particular, “voices” in the head);
• increased agitation and irritability;
• progressive withdrawal;
• splitting of mental processes;
• motor-volitional disorders (for example, catatonic stupor).

One of the symptoms of schizophrenia is often obsessive fears or phobias.

Please note: To reduce anxiety, the patient often needs to perform some kind of “ritual”. For example, if he is afraid of contracting an infectious disease or fear of dirt, he needs to wash his hands a strictly certain number of times. If it is not possible to do this, then anxiety and fear increase.

Fear and anxiety are the most common manifestations of depression in schizoaffective psychosis in adolescents. Melancholy may not be noted at all, or it may fade into the background. The depressed mood is understood by the patients themselves as a consequence of fear and anxiety.

Most of all they fear death or reprisals. Fear for the life and well-being of the mother and other loved ones is very typical. Such an attitude towards relatives distinguishes patients with schizoaffective psychosis from those who suffer from other forms of schizophrenia, where one can more often find a negative and even aggressive attitude towards loved ones.

The plot for anxious fears can be experiences that are not uncommon in adolescence: fear that they will be hostile, or fear that they will be “punished,” “caught,” “sent” for previously committed offenses. Fear and anxiety may seem unreasonable even to the sickest person. He cannot understand what he is afraid of (“vital fear”, “vital anxiety”) or only vaguely senses how something terrible is about to happen, like the death of all humanity from a nuclear war or some other world catastrophe. Occasionally one encounters “fear of fear” (“I’m always afraid that fear will return again”). The fear of going crazy is facilitated by feelings of difficulty in thinking.

Fear and anxiety are clearly reflected in the patient’s entire behavior - in the intonation of the voice, facial expressions, gestures, and postures. Motor activity is very different - from fussy restlessness, a desire to go somewhere all the time, to travel, continuous marking time, the inability to sit quietly to almost complete immobility, numbness with a frozen expression of fear on the face. Feelings of anxiety and fear may suddenly intensify. Then the patients rush about, rush somewhere, wring their hands, cry, scream, moan (anxious raptus).

Thinking is not so much slow as in typical melancholic depression, but difficult. They ask questions again and repeat the same thing over and over again. Very often they complain of “emptiness in the head” (as opposed to the influx of thoughts during a manic state). This feeling of emptiness is quite constant, it is different from the sudden delays of thought (“sperrungs”) in progressive schizophrenia.

Anxiety and fear serve as the basis on which delusions of persecution, attitudes and self-blame easily arise. A typical statement by a teenager is that “everyone is looking at him.” The views of others are perceived as condemning (“they look and turn away”, “they despise”, “they guess that he was engaged in masturbation”, etc.), or threatening (“they want to deal with them”, “to let you down”). The initial experiences for delirium are often events in the days preceding the onset of the illness. If you watch a detective film, then it becomes an impetus for the development of ideas of persecution; a message about a comet approaching the earth - for fear of an impending world catastrophe; information gleaned from somewhere about the proliferation of portable listening devices in America - for the belief that “everything about me is being recorded all the time.”

Delusions of self-blame and delusions of persecution, relationships, and infections can be closely intertwined with each other. The teenager believes that because of his behavior his mother will be arrested or for the fact that he lost money in the company and did not give it back, that his family will be dealt with, that they get pimples and boils from him, that they laugh at him because he has ““ stupidity is visible on the face." Believes that he has syphilis and is therefore dangerous to others, or that he should be sent to prison because he once tried some kind of intoxicating drug.

Delusions of enactment can also occur in depression, but also reflect the interweaving of ideas of persecution and self-blame. For example, a teenager considers other patients to be disguised as police agents who are watching him and “should put him under arrest” for previous violations. Another is convinced that he is considered a “scumbag”, and therefore a “corrupting environment” has been artificially created around him (“they allow you to smoke in the toilet... the guys talk about indecent things”) in order to provoke him and he would “give himself away.”

Phenomena of depersonalization and derealization may occur (“everything seems lifeless,” “everything seems dead,” “I’m like a different person”). Auditory hallucinations are episodic. Threats and reproaches are heard.

Suicidal behavior may also reflect a combination of guilt and fear. Fearing that he will be killed, the patient himself can nevertheless commit serious suicidal acts or surrender his life to chance. For example, a teenager deliberately walked in the middle of the pavement along a street with heavy traffic, hoping that he would be run over to death.

Sexual desire is usually suppressed. But several times I heard from teenagers in a state of anxious depression that “masturbation calms you down for a while.”

Daily mood fluctuations are unclear and may be absent altogether [Iovchuk N. M., 1977]. Sometimes anxiety increases in the evening, sometimes, on the contrary, by the end of the day patients feel calmer. Restless sleep. There are food refusals. Patients lose weight quite quickly.

Differential diagnosis with other depressive syndromes is not particularly difficult. Delusions and hallucinations in this syndrome, if they occur, are closely related to the affective background and are usually episodic. In paranoid depression, delusions and hallucinations are distinguished by great persistence and variety; they may not arise directly from the affect of anxiety, fear or melancholy, but in the clinical picture they turn out to be the leading symptoms.

It can be more difficult to distinguish from acute polymorphic syndrome (see page 127) in the first days, since in this syndrome anxiety and fear can also be pronounced, but they are not constant, they can alternate with apathy, then with exaltation and even euphoria . This syndrome is more characterized by affective lability. In addition, the ability to understand what is happening around becomes difficult, fine orientation may be lost, and delusional statements and hallucinations may not be associated with an affective background; pseudohallucinations, mental automatisms, and even individual hebephrenic and catatonic symptoms are possible.

Treatment

Treatment of schizophrenia must be comprehensive. Trying to get rid of only one of the symptoms (in particular, fears) does not make sense. Currently, non-drug treatment methods are widely used in the treatment of schizophrenia, which include:

• kinesiotherapy;
• light therapy;
• biofeedback.

If the use of pharmacological drugs is indicated, then one antipsychotic drug and an additional 1-2 psychotropic drugs are usually prescribed. To treat fears in schizophrenia, as well as get rid of hallucinations and delusions, it is advisable to choose an atypical antipsychotic drug. Medicines in this group additionally provide a primary inhibitory effect. Long-term course treatment is indicated. After the first manifestations of the disease, psychotropics and antipsychotics should be taken for 2 years, and after the second episode - for at least 5 years.

In clinical practice, anti-anxiety drugs from the group of benzodiazepine tranquilizers (Phenazepam, Seduxen, Elenium) are used to treat fears and phobias. To get rid of fear against the background of mental disorders, serotonergic and tricyclic antidepressants (Triptisol, Amitriptyline) are also prescribed.

A well-chosen dosage regimen gives a noticeable positive effect after a week of course treatment. Treatment of fear in schizophrenia may involve the use of psychotherapeutic techniques. Neurolinguistic programming, as well as behavioral and rational psychotherapy, have proven their effectiveness.

The text was checked by expert doctors: Head of the socio-psychological service of the Alkoklinik MC, psychologist Yu.P. Baranova, L.A. Serova, a psychiatrist-narcologist.

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Schizophrenics are dangerous to society due to cruelty and aggressiveness

This is also partly a myth. Many people have the impression that people with schizophrenia pose a threat to others. Mostly this is the negative influence of media and films. In fact, people with schizophrenia are as harmless as children. On the contrary, they themselves often become targets of criminal attacks.

A different scenario happens in the absence of proper treatment. Then, in the acute stage of the disease, a person is prone to violence under the influence of visions and delusional thoughts. It’s more scary when there are hallucinations of an auditory nature in the form of a call for specific hostile actions.

For example, in 2015, one resident of Nizhny Novgorod, during an exacerbation of schizophrenia, killed his own family (six children, wife and mother). He explained the action by saying that he heard an order to act in this way. Belov suffered from schizophrenia for a long time and repeatedly showed aggression towards his wife. Relatives tried to keep it a secret and did not seek help from doctors.

No less dangerous are delusional states associated with persecution mania. A person sees everyone and everything around him as a threat to himself. To protect himself, he often begins to defend himself from supposedly attacking people. Therefore, during an exacerbation of schizophrenia, relatives close to the patient are at greater risk.

Schizophrenia can develop due to flaws in upbringing

One of the causes of schizophrenia is considered to be improper upbringing. In particular, we are talking about a lack of attention from the mother. In fact, blaming parents in this matter is baseless. No matter how coldly they treat their own child, this cannot provoke illness years later. Schizophrenia is a serious mental disorder, the development of which is caused by a whole complex of negative factors. Here are some of them:

• predisposition at the genetic level;
• head injuries;
• frequent stressful situations;
• brain dysfunction and so on.

There are still many questions in this regard to which scientists have not received accurate answers.

Manifestations of the disease

Certain difficulties in identifying the disease are associated with the fact that at the initial stage of the disease the patient almost completely lacks such typical symptoms of schizophrenia as delusions or hallucinations. The patient expresses monotonous emotions, does not show initiative, and becomes less active. A person’s intellect becomes dull, and minor oddities and eccentricities appear in their way of thinking, interests and behavior.

Over time, speech may become incomprehensible and confused. But others may not notice these changes, since they last for several months or even years. The shallow personality disorders that can be observed in those suffering from indolent schizophrenia make it possible for them to maintain the required level of adaptation in the family and at work throughout their lives.

In this case, they give the impression of an ordinary or slightly eccentric person to others. Since the signs and symptoms of sluggish schizophrenia are similar to the manifestations of other mental pathologies (depression, neuroses, psychopathy, etc.), only constantly practicing highly qualified specialists with extensive clinical experience can diagnose this type of mental disorder.

Acute sensual delirium

Paranoid schizophrenia is one of its most common forms. As the patient's condition worsens, his thinking and perception of the world becomes distorted under the influence of hallucinations and fantasies. The following symptoms are observed:

• emotionally rich insights;
• lack of logical thinking;
• delusional interpretation of visions.

With sensory delirium, sudden, bright, rich pictures appear, causing strong feelings and emotions. Kandinsky syndrome may occur. The patient may claim that:

• he does not control his speech, since his mouth no longer obeys him;
• there are voices within him that tell him what to do;
• he is pursued by various fantastic and mythical creatures.

With figurative delirium, scattered, fragmentary visions of reality appear, indistinguishable from fiction, but based on a person’s past experience.

Schizophrenia leads to dementia

In life, you can encounter different clinical variants of the development of schizophrenia. Each case is individual. In some, the development of schizophrenia is practically asymptomatic and does not in any way affect mental capabilities. Such patients are still able to think rationally, learn successfully, and do not suffer from memory loss and other manifestations characteristic of schizophrenia.

Other people with a similar diagnosis show obvious deviations at the emotional and mental level. With each new attack, the situation worsens and over time leads to the fact that the person is unable to independently perform basic everyday activities, much less work. There are especially severe forms when the disease progresses rapidly and quickly leads to disability.

No doctor can say for sure what awaits a person with schizophrenia. Despite numerous studies in this direction, science is still powerless. You can compare the state of the brain at different time stages, based on which you can make an approximate forecast.

Cases have been recorded where people suffering from schizophrenia for a long time remain completely adequate and do not lose basic life skills. For example, Nobel laureate D.F. Nash was schizophrenic. But this did not stop him from successfully teaching at the university.

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Stages of development and forms of the disorder

In the development process, there are three main stages of the disease: latent (debut), active (manifest) stages and a period of stabilization of the patient’s condition.

During the active stage of the disease, symptoms may clearly manifest themselves in various combinations with a sluggish course or acute attacks:

• symptoms of depersonalization;
• hypochondria;
• psychoses and hysterics;
• prolonged neuroses;
• affective state.

The disease can also be accompanied by increased anxiety, various phobias, panic attacks, various rituals that involve double-checking some actions and facts, obsessive doubts, and fear of external influences.

Sluggish schizophrenia can occur in the following forms:

• psychopathic (pseudopsychopathic)
  – characterized primarily by symptoms of personality disorders reminiscent of psychopathic disorders (explosive character, mannerisms, eccentric behavior, etc.);
• neurosis-like (pseudo-neurotic)
  - manifests itself predominantly with neurotic symptoms (phobias, anxiety, insomnia, etc.) accompanied by mild symptoms of schizophrenia.
• latent
  – ​​the most favorable type of pathology, since it is characterized by the presence of vague symptoms, the disease does not progress to manifest from the debut stage of development;
• asthenic
  - a relatively mild form with symptoms of rapid fatigue from any type of activity, communication with representatives of asocial strata, collecting - common characteristics of this form;
• without productive disorders
  - characterized by the absence of productive symptoms (detecting the disease) against the background of visible negative symptoms - damage to body functions, disappearance of various abilities;
• obsessive
  – characterized by an obsessive state up to the point of worshiping an object or phenomenon, performing an invented ritual before certain actions;
• hypochondriacal
  – a persistent belief in a non-existent dangerous disease, observed most often in adolescents, women during menopause, pregnant women, when hormonal changes occur;
• hysterical
  – women are more susceptible, manifests itself in seizures with sudden mood swings from sobbing to laughter, the development of “magical thinking”, hallucinations, and a tendency to wander is possible;
• depersonalized
  – a disorder of self-perception (typical mainly for adolescents), perception of one’s body and its functions, and the outside world;
• affective with a disturbance of the emotional state of 2 types
  - manic or hypomanic against a background of general malaise and weakness.