Schizophrenia and work, can schizophrenics work? Is schizophrenia completely curable? Test for schizophrenia

– a mental disorder accompanied by the development of fundamental disturbances in perception, thinking and emotional reactions. It is distinguished by significant clinical polymorphism. The most typical manifestations of schizophrenia include fantastic or paranoid delusions, auditory hallucinations, disturbances in thinking and speech, flattening or inadequacy of affects and gross violations of social adaptation. The diagnosis is established on the basis of anamnesis, interviews with the patient and his relatives. Treatment – ​​drug therapy, psychotherapy, social rehabilitation and readaptation.

ICD-10

F20

General information

Causes of schizophrenia

The causes of the occurrence have not been precisely established. Most psychiatrists believe that schizophrenia is a multifactorial disease that occurs under the influence of a number of endogenous and exogenous influences. A hereditary predisposition is revealed. If you have close relatives (father, mother, brother or sister) suffering from this disease, the risk of developing schizophrenia increases to 10%, that is, approximately 20 times compared to the average risk in the population. At the same time, 60% of patients have an uncomplicated family history.

Factors that increase the risk of developing schizophrenia include intrauterine infections, complicated labor and time of birth. It has been established that people born in spring or winter are more likely to suffer from this disease. There is a strong correlation between the prevalence of schizophrenia and a number of social factors, including the level of urbanization (urban residents get sick more often than rural residents), poverty, unfavorable living conditions in childhood, and family moves due to unfavorable social conditions.

Many researchers point to the presence of early traumatic experiences, neglect of vital needs, and sexual or physical abuse suffered in childhood. Most experts believe that the risk of schizophrenia does not depend on parenting style, while some psychiatrists point to the possible connection of the disease with gross violations of family relationships: neglect, rejection and lack of support.

Schizophrenia, alcoholism, drug addiction and substance abuse are often closely related to each other, but it is not always possible to trace the nature of these connections. There are studies indicating a connection between exacerbations of schizophrenia and the use of stimulants, hallucinogens and some other psychoactive substances. At the same time, an inverse relationship is also possible. When the first signs of schizophrenia appear, patients sometimes try to eliminate unpleasant sensations (suspicion, worsening mood and other symptoms) by using drugs, alcohol and medications with psychoactive effects, which entails an increased risk of developing drug addiction, alcoholism and other addictions.

Some experts point to a possible connection between schizophrenia and abnormalities in the structure of the brain, in particular with enlarged ventricles and decreased activity in the frontal lobe, which is responsible for reasoning, planning and decision-making. Patients with schizophrenia also show differences in the anatomical structure of the hippocampus and temporal lobes. At the same time, the researchers note that these disorders could arise secondary, under the influence of pharmacotherapy, since most of the patients who took part in studies of brain structure had previously received antipsychotic drugs.

There are also a number of neurochemical hypotheses linking the development of schizophrenia with disruption of the activity of certain neurotransmitters (dopamine theory, keturene hypothesis, hypothesis about the connection of the disease with disorders in the cholinergic and GABAergic systems). For some time, the dopamine hypothesis was especially popular, but subsequently many experts began to question it, pointing out the simplified nature of this theory, its inability to explain clinical polymorphism and the many variants of the course of schizophrenia.

Classification of schizophrenia

Based on clinical symptoms, the DSM-4 distinguishes five types of schizophrenia:

• Paranoid schizophrenia– there are delusions and hallucinations in the absence of emotional flattening, disorganized behavior and thinking disorders
• Disorganized schizophrenia(hebephrenic schizophrenia) – thinking disorders and emotional flattening are identified
• Catatonic schizophrenia– psychomotor impairments predominate
• Undifferentiated schizophrenia– psychotic symptoms are revealed that do not fit into the picture of catatonic, hebephrenic or paranoid schizophrenia
• Residual schizophrenia– mild positive symptoms are observed.

Along with those listed, the ICD-10 identifies two more types of schizophrenia:

• Simple schizophrenia– gradual progression of negative symptoms is detected in the absence of acute psychosis
• Postschizophrenic depression– occurs after an exacerbation, characterized by a persistent decrease in mood against the background of mildly expressed residual symptoms of schizophrenia.

Depending on the type of course, domestic psychiatrists traditionally distinguish between paroxysmal-progressive (coat-like), recurrent (periodic), sluggish and continuous schizophrenia. Division into forms taking into account the type of course allows you to more accurately determine the indications for therapy and predict the further development of the disease. Taking into account the stage of the disease, the following stages of development of schizophrenia are distinguished: premorbid, prodromal, first psychotic episode, remission, exacerbation. The final state of schizophrenia is a defect - persistent deep disturbances in thinking, decreased needs, apathy and indifference. The severity of the defect can vary significantly.

Symptoms of schizophrenia

Manifestation of schizophrenia

Typically, schizophrenia manifests itself during adolescence or early adulthood. The first attack is usually preceded by a premorbid period of 2 or more years. During this period, patients experience a number of nonspecific symptoms, including irritability, mood disturbances with a tendency toward dysphoria, bizarre behavior, sharpening or distortion of certain character traits, and a decrease in the need for contact with other people.

Shortly before the onset of schizophrenia, a prodrome period begins. Patients are increasingly isolated from society and become distracted. Nonspecific symptoms are accompanied by short-term psychotic-level disorders (transient overvalued or delusional ideas, fragmentary hallucinations), turning into full-blown psychosis. Symptoms of schizophrenia are divided into two large groups: positive (something appears that should not be normal) and negative (something that should be normal disappears).

Positive symptoms of schizophrenia

Hallucinations. Typically, auditory hallucinations occur in schizophrenia, in which the patient may believe that voices are sounding in his head or coming from various external objects. Voices may threaten, command, or comment on the patient's behavior. Sometimes the patient hears two voices at once arguing with each other. Along with auditory hallucinations, tactile hallucinations are possible, usually of an elaborate nature (for example, frogs in the stomach). Visual hallucinations are extremely rare in schizophrenia.

Delusional disorders. With delusions of influence, the patient believes that someone (enemy intelligence, aliens, evil forces) is influencing him using technical means, telepathy, hypnosis or witchcraft. With delusions of persecution, a patient with schizophrenia thinks that someone is constantly watching him. Delusions of jealousy are characterized by an unshakable conviction of the spouse's infidelity. Dysmorphophobic delirium is manifested by confidence in one’s own ugliness, in the presence of a gross defect in some part of the body. With delusions of self-blame, the patient considers himself to be responsible for the misfortunes, illnesses or deaths of others. With delusions of grandeur, a person with schizophrenia believes that he occupies an exceptionally high position and/or has extraordinary abilities. Hypochondriacal delusions are accompanied by a belief in the presence of an incurable disease.

Obsessive ideas, disorders of movement, thinking and speech. Obsessive ideas are ideas of an abstract nature that arise in the mind of a patient with schizophrenia against his will. As a rule, they are global in nature (for example: “what will happen if the Earth collides with a meteorite or leaves orbit?”). Movement disorders manifest themselves in the form of catatonic stupor or catatonic agitation. Disorders of thinking and speech include obsessive philosophizing, reasoning and meaningless reasoning. The speech of patients suffering from schizophrenia is replete with neologisms and overly detailed descriptions. In their reasoning, patients randomly jump from one topic to another. With severe defects, schizophasia occurs - incoherent speech devoid of meaning.

Negative symptoms of schizophrenia

Emotional disorders. Social isolation. The emotions of patients with schizophrenia are flattened and impoverished. Hypothymia (sustained decrease in mood) is often observed. Hyperthymia (sustained increase in mood) occurs less frequently. The number of contacts with others decreases. Patients suffering from schizophrenia are not interested in the feelings and needs of loved ones, stop going to work or school, and prefer to spend time alone, being completely absorbed in their experiences.

Disorders of the volitional sphere. Drifting. Drift is manifested by passivity and inability to make decisions. Patients with schizophrenia repeat their usual behavior or reproduce the behavior of others, including antisocial behavior (for example, drinking alcohol or taking part in illegal activities), without feeling pleasure and without forming their own attitude to what is happening. Volitional disorders are manifested by hypobulia. Needs disappear or decrease. The circle of interests is sharply narrowed. Sexual desire decreases. Patients suffering from schizophrenia begin to neglect hygiene rules and refuse to eat. Less commonly (usually in the initial stages of the disease), hyperbulia is observed, accompanied by an increase in appetite and sexual desire.

Diagnosis and treatment of schizophrenia

The diagnosis is established on the basis of anamnesis, interviews with the patient, his friends and relatives. To make a diagnosis of schizophrenia, one or more first-rank criteria and two or more second-rank criteria defined by ICD-10 must be present. The criteria of the first rank include auditory hallucinations, the sound of thoughts, fanciful delusional ideas and delusional perceptions. The list of criteria for schizophrenia of the second rank includes catatonia, interruption of thoughts, persistent hallucinations (except auditory), behavioral disturbances and negative symptoms. Symptoms of the first and second ranks must be observed for a month or more. To assess the emotional state, psychological status and other parameters, various tests and scales are used, including the Luscher test, Leary test, Carpenter scale, MMMI test and PANSS scale.

Treatment of schizophrenia includes psychotherapy and social rehabilitation measures. The basis of pharmacotherapy are drugs with antipsychotic effects. Currently, preference is often given to atypical antipsychotics, which are less likely to cause tardive dyskinesia and, according to experts, can reduce the negative symptoms of schizophrenia. To reduce the severity of side effects, antipsychotics are combined with other medications, usually mood stabilizers and benzodiazepines. If other methods are ineffective, ECT and insulin comatose therapy are prescribed.

After the reduction or disappearance of positive symptoms, the patient with schizophrenia is referred to psychotherapy. Cognitive behavioral therapy is used to train cognitive skills, improve social functioning, and help people understand the characteristics of their own condition and adapt to this condition. To create a favorable family atmosphere, family therapy is used. They conduct training sessions for relatives of patients with schizophrenia and provide psychological support to relatives of patients.

Prognosis for schizophrenia

The prognosis for schizophrenia is determined by a number of factors. Prognostically favorable factors include female gender, late age of onset of the disease, acute onset of the first psychotic episode, mild severity of negative symptoms, the absence of prolonged or frequent hallucinations, as well as favorable personal relationships, good professional and social adaptation before the onset of schizophrenia. The attitude of society plays a certain role - according to research, the absence of stigma and acceptance of others reduces the risk of relapse.

It is believed that a person diagnosed with schizophrenia has mental disorders that accompany him throughout his life. However, this is not quite true. If the disease is diagnosed at an early stage of development and all necessary measures are taken to treat this disease, then there is a possibility that the person will live a normal, full life.

Is there a cure for schizophrenia?

There is an established opinion in society that it is impossible to recover from schizophrenia and that it is a stamp for life. In fact, you shouldn’t be so skeptical about this diagnosis. So is schizophrenia curable? To answer the question, it is recommended to look at this diagnosis from a different angle. Namely, treat this disease like any other chronic illness. As an example, consider a disease such as diabetes. Humanity has not come up with a way to get rid of it, but there are certain rules, following which, a person can lead a normal life and keep his body in good shape. So is schizophrenia treatable or not? When answering this question, it is necessary to take into account that if you learn to follow certain rules, then it will become possible to exercise control over your condition.

Each person is individual, and schizophrenia has its own characteristics. They may manifest themselves differently in different people. There are statistics that one in five people with schizophrenia gets better after five years. At this stage, you should understand what improvement means and whether schizophrenia is treatable. Let's figure it out now.

How do improvements in this disease manifest themselves?

First, it should be understood that improvement is a long-term process in a disease such as schizophrenia. Psychiatry identifies several aspects of this condition. Secondly, you need to know that the recovery process implies a person’s desire to constantly work and achieve their goals. During this period, the patient will experience both normalization of the condition and exacerbation of the disease. An important point is the support of loved ones who can provide the necessary help at the moment when a person diagnosed with schizophrenia needs it.

Psychiatry says that improving the condition of a person who is sick with this disease means minimizing the symptoms of the disease and preventing attacks. It is also necessary to establish a normal perception of reality for the patient, thanks to which he will be able to lead a normal life.

What influences the positive outcome of treatment?

And women are usually the same. But there are also differences. They lie in the fact that the symptoms of schizophrenia in men are more aggressive and frightening. They need the attention and understanding of loved ones.

They have a softer character. Hallucinations occur. An interesting fact is that this disease can be triggered by childbirth. When answering the question of whether schizophrenia can be treated in women, it should be taken into account that this is a hereditary disease. And it is treatable to the same extent as in men. But if we talk about whether schizophrenia can be treated in adolescents, the important point here is the early diagnosis of the disease.

Facts to pay attention to during treatment

It is worth saying that modern medicine does not offer any specific methods by which a person can be cured of schizophrenia. But this disease is treatable. There are also ways to prevent attacks and exacerbations of the disease. If the patient has the right attitude and strives for recovery, then he has every chance of becoming a full-fledged member of society and leading a normal lifestyle, working, etc.

If a person is diagnosed with schizophrenia, this does not mean that he needs to constantly be in a hospital. With the correct and timely approach to treatment, the patient will be able to avoid crisis situations in which medical examination of the patient and keeping him under observation may be necessary. It should be remembered that in any situation there is hope for recovery. The main thing is not to be discouraged, but to take certain actions. Thanks to them, you can achieve the desired results.

Non-medical methods for diagnosing varonia

There is a test for schizophrenia that you can take. Please note that this test is not a basis for making a diagnosis. It shows whether a person is predisposed to such a disease or not. The test for schizophrenia presents a set of questions. By answering them, a person gains a certain number of points. The developers of the test have determined the norm. It is believed that if a person has scored points and they do not exceed a certain amount, then he is not prone to schizophrenia. The test is psychological in nature.

The questions are quite simple, for example, “do your relatives irritate you” or “do you have obsessive thoughts” and so on. In addition to the test method, where you need to answer questions, there is an optical illusion test. It's called Chaplin's mask. It is assumed that healthy people can see Chaplin's bulbous face on both sides of the mask. And those who are prone to mental illness see the second side of the mask as concave. These methods do not have any medical accuracy.

Treatment methods for schizophrenia. Patient participation in the therapy process

First of all, it is necessary that the person is correctly diagnosed. The staging process requires a fairly long period of time. Since the symptoms of this disease can overlap with other human mental disorders. Making a diagnosis requires time to monitor the patient. In addition, it is better if it is done by someone who has experience in treating such people.

Therefore, at the first suspicion of schizophrenia or a mental disorder, you should consult a doctor. This should be done. Because effective treatment requires a correct diagnosis. And based on this, they will prescribe a treatment regimen for the disease. If the diagnosis is made accurately, then therapy will be effective.

There are cases when a person who does not realize this himself resists what he is told that he is not entirely healthy. But relatives who see mental abnormalities need to see a doctor. If a person himself notices this kind of problem in his body, then he is also recommended to seek medical help.

A sick person needs to know that treating schizophrenia requires an integrated approach. This disease cannot be cured simply by taking medications. In addition, it is necessary to ensure communication with doctors, relatives, and have psychological support from loved ones. It is important not to drop out of society, but to continue communicating with people around you. You should also lead a healthy lifestyle and eat right. A healthy lifestyle means following a daily routine, walking, and exercising.

Another important factor that will ensure the recovery process in schizophrenia is that the patient is an active participant in the treatment. The patient needs to tune in to participate in this process, talk through his feelings from taking this or that drug, talk about his well-being and share his emotional mood with loved ones and the attending physician.

The course of schizophrenia and the patient’s mood for recovery

First of all, you should not fall into despair. If there are people around a person who has been diagnosed with schizophrenia who believe that this illness is incurable, then you should not communicate with them. It is better that those for whom this person remains an individual, regardless of illness, are present. You need to constantly maintain a relationship with your doctor. It is recommended to monitor the dosage of medications prescribed by the psychiatrist. If a patient has concerns that he has been prescribed a dose of medication that is too high or, conversely, too small, then he should definitely talk to his doctor. He needs to voice his concerns about this. You should also clarify what possible side effects from taking a particular drug. It is important for the patient to be honest with himself and the psychiatrist. If the patient observes side effects, then you need to tell the doctor about this and change the treatment regimen or change the amount of the drug. The patient should know that determining the dosage of medications is a joint effort between the doctor and the patient. Therefore, you need to take an active part in it.

Also, a person diagnosed with schizophrenia should learn to use special therapy, which includes the ability to control the symptoms of this disease. Namely, if the patient has any obsessive thoughts or hears extraneous voices, then through special therapy he can switch and lead himself away from these conditions. The patient should also learn to motivate himself to do something.

For schizophrenics, setting and achieving goals is an important part of the recovery process. Under no circumstances should you give up society.

Patient support

Those patients who receive support from relatives and other close people are very lucky. The participation of others in the treatment process is an important component of recovery. It has also been found that when the patient is surrounded by understanding and kindness, the occurrence of relapses is minimized.

A person who is ill is advised to talk with relatives and friends who, in his opinion, can help if attacks of schizophrenia occur. It is necessary to explain to them what type of help is expected from them. As a rule, when people ask for help, they are met. Especially when it comes to health. With support, it will be easier for a patient diagnosed with schizophrenia to cope with the illness.

Another important factor that will contribute to recovery is work. It is better for people with mental disabilities to work. If, of course, the state of health allows and there is no disability due to schizophrenia. Voluntary labor can be used. There are communities of people suffering from this disease. To avoid this, it is recommended to join them. Visiting temples helps some people. You need to create a favorable environment around yourself. The same rule can be followed by healthy people. The difference is that a mentally healthy person can cope with stress or psychological discomfort. And it is better for a person with disabilities to avoid situations that could cause a relapse.

A favorable circumstance for the patient is living with a family. Love and understanding of loved ones are one of the main positive factors for recovery from schizophrenia. Under no circumstances should you consume alcohol or drugs. Since they have a negative effect on the body of a sick person.

People diagnosed with schizophrenia are prescribed antipsychotic medications. It should be remembered that the treatment of this disease is complex. Therefore, taking medications is one of the components of therapy.

You also need to understand that these medications do not cure a person for a disease such as schizophrenia. Their action is aimed at eliminating the symptoms of this disease, such as hallucinations, delusions, obsessive thoughts, chaotic thinking, etc.

Taking these drugs will not ensure a person’s entry into society, setting any goals or motivating them to take certain actions.

Negative effects of drugs

Also, this type of drug has a number of associated manifestations:

1. Drowsiness.
2. Prostration.
3. Chaotic movements may occur.
4. Excess weight appears.
5. Sexual function is lost.

If these manifestations interfere with normal life, you should consult a doctor and reduce the dose of drugs or change the treatment regimen.

It is not recommended to reduce the amount of medication on your own or switch to another drug. This can be harmful to health, cause relapse, etc. Therefore, a consultation with a psychiatrist is required.

How to find the optimal drug?

The main task in finding the right medicine for schizophrenia is that it has the desired effect and side effects are kept to a minimum. It should also be taken into account that a person takes such drugs for a long time, sometimes for life. Therefore, you need to be very careful when choosing. If necessary, change to another medicine.

The difficulty in choosing an antipsychotic drug is that it is unclear how it will affect the body and what side effects may occur. Therefore, the process of selecting a drug can be quite long and complex. It is also necessary to choose the right dosage for each individual patient.

As a rule, improvement in the patient’s condition after starting to take medications occurs after one and a half or two months. There are cases when a person feels better after a few days. When there is no positive dynamics even after two months, you need to either increase the dose or change the drug.

So is schizophrenia completely curable? Cannot be guaranteed 100%. But it is possible to remove its symptoms.

What types of medications are prescribed for schizophrenia?

Currently, drugs prescribed for this disease can be divided into two groups. Namely, medicines of the old generation and the new. The first drugs include antipsychotics. And for new ones - atypical drugs.

Neuroleptics have been known for a long time; they eliminate hallucinations, obsessive thoughts, etc. But they have drawbacks. They can cause unpleasant symptoms such as:

1. Anxiety.
2. Slowness.
3. Unsteady gait.
4. Painful sensations in the muscles.
5. Temporary paralysis may occur.
6. Spasms.
7. Chaotic movements.

The new generation of drugs is called atypical antipsychotic drugs. In recent years, they have been used more often to treat this disease. This is due to the fact that there are much fewer side effects from taking these medications.

Anyone who reads at least one case history of schizophrenia will be convinced that psychiatry is an almost exact science. This is a document that is drawn up before the patient is discharged. It can also arise in situations when some events occur related to his future fate, for example, an extension of treatment or before some kind of examination, transfer to another department. In the medical history of the paranoid form of schizophrenia, like various other disorders, there must be mandatory sections and they go in a certain order. There are no clear instructions on what exactly to write and how, much is left to the doctor, but he must write certain things. After the passport details and date of admission to the hospital, a detailed description of the situation begins.

When treating schizophrenia, the doctor must take and maintain a medical history.

This section describes either the patient's complaints or the reasons for his admission to the hospital. A record like this may appear. “During the survey, no complaints were identified. The reason for hospitalization was a change in behavior for an unspecified period. Showed aggressiveness towards neighbors. The day before hospitalization, he tried to beat up a colleague.”

Anamnesis of life

The main biographical facts that are interesting from the point of view of psychiatry are described. If the patient is young, then records may appear about how he studied at school, college, and what kind of relationships he had with other students and teachers. The family, the relationships in it in general and the relationships between family members and the patient are described. To the point that “as a child I was hyperactive, often offended my younger brother, took his toys” or “at the age of 10 I ran away from home due to a conflict in the family.” Attention is paid to the economic status of the family and the patient himself. It tells about who he works for, what kind of relationships he has with his colleagues.

Serious diseases that the patient denies and those that he had or still have are listed. These are tuberculosis, malaria, syphilis and the like. It is also written about whether the patient drinks alcohol, drugs, or whether he has had any poisoning.

All this information is recorded from the words of the patient or relatives, acquaintances, if it is possible to interview them. Sources can also be references and various documents.

Medical history

Sometimes this section is combined with a life history. They don't write about mental state here. This is a description of the situation itself, a look at behavior, previous treatment, if any, reasons for hospitalization in more detail. It does not yet indicate that this is a medical history of a patient with paranoid schizophrenia. There is another section for diagnosis.

The medical history includes all medications prescribed by the doctor.

It looks something like this...

“According to relatives, signs of the disorder first began to appear in 2010. She ran around the apartment naked, scared the neighbors, looked for devils in the corners, kicked out the water tap, grabbed knives and sharp objects. She was hospitalized and underwent treatment at TCHB No. 2 from 06/01/10 to 08/10/10. After discharge, she did not visit a psychiatrist and did not take any medications. Drank alcohol. No deviations in behavior were observed until May 2017. On 05/03/17 she announced that she intended to poison everyone, caused bodily harm to relatives, sang songs and shouted in an incomprehensible language.”

In psychiatry there are a variety of case histories. Someone received a “call” from Putin at work, and after that he flew into a rage and broke a window, and someone complains of harassment from relatives. This is the case if the patients are talkative and can somehow describe their adventures.

Mental condition

A generalized story about the results of observation during the entire stay in the hospital - it lasted five days or a month. Sometimes the section is called “Mental Status”.

The patient’s behavior during communication with the doctor, his speech, gestures, and characteristic posture must be indicated. Does he deny his bad behavior, if any, and how does he generally assess his condition? The degree of orientation in time, place and personality is indicated.

• perception;
• thinking.

This can be expressed like this: “Thinking is paralogical, slipping, slow in pace, there is affectivity, there is no consistency.” If there is delirium, then the patient may be cited. It is also described:

• sphere of feelings;
• sphere of memory;
• patient attention;
• character traits;
• level of intellectual development.

Finally, general characteristics of behavior in the department are given - discipline, attitude to treatment, relationships with other patients. No schizophrenia is mentioned in this case. Mental status is a description of the state of the psyche when abstracting from diagnosis...

However, the mental status will already allow us to make a preliminary conclusion that this is paranoid or hebephrenic schizophrenia, but the main details have not yet been outlined.

Neurological status

The section is filled out based on the doctor’s understanding of what is most important in relation to the patient. They can write about the state of the pupils and reaction to light, and describe the motor sphere. Very often the essence of the information comes down to the exclusion of something, for example, traumatic brain injury.

The medical history may even describe the condition of the patient’s pupils

Somatic status

Patients in psychiatric clinics undergo a full medical examination and undergo many tests - blood, urine, etc. Data on them is entered into the section describing the physical condition. A detailed description of the various systems is also possible:

• respiratory organs;
• blood circulation;
• digestion

Rationale for diagnosis

The most important part. Diagnostics can be expressed in one section of justification, or there may also be a section “Differential diagnosis”. First, of course, the diagnosis itself is written. Domestic doctors do not always prescribe codes from ICD 10. Many formulations do not repeat the formulations from this classifier. As a result, the following phrase from the medical history may appear: “Paranoid schizophrenia, continuous, depressive-paranoid syndrome in the structure of an emotional-volitional defect.” Formally, they haven’t left the ICD; it’s all there, but it’s expressed differently. There is no hint of the term “Schizoaffective Disorder”. If paranoid, then F20.0, but what does affect have to do with it? And why did they have to diagnose both in the new and old way? There is no need to think that this is due to illiteracy. The patient was rowdy, beat up one of her relatives, and did not know what she was doing. In the hospital she came to her senses a little, agreed to the treatment, and is behaving well. The doctor also wants to create a section “Expert Assessment” at the very end of the document, and write in it that most patients with schizophrenia are recognized as insane if they committed criminal acts at the time of the episode. And he calls it “continuous.” Nobody asked him to do this section. The sanity analysis will be carried out by another examination if it is ordered by the court. He pointed out in the medical history the paranoid form of schizophrenia, showed its malignant course and thus told the doctors of another examination his opinion. In simple words, it will be like this: “Colleagues, I assure you that she did not understand what she was doing.”

Following the diagnosis, write its rationale. What criteria is it based on?

Let's come up with something that isn't so intense. A diagnosis that is well suited for revealing the topic of a medical history is:

“Schizophrenia, paranoid form, paroxysmal-progressive course. Kandinsky-Clerambault syndrome."

This is a classic of the genre. This type of paranoid schizophrenia is included in a huge number of case histories: a furry-like course, an increase in negative factors from episode to episode, and one of the main forms of delusion. Below are possible points of justification.

1. Signs of thinking disorder. And we list what we possibly find. This may be paralogicality, reasoning, fragmentation, ambivalence.
2. Stopping personal development. This is the case when the patient does not work for a long time and is not looking for work, is not interested in anything, does not strive for anything. For scientific purposes, such a development could be called ontogenetic, so that the document would look more impressive.
3. Constant loss of strength.
4. Reduced emotional resonance. For example, a patient talks about some terrible things without any emotional expression.
5. Perinuclear type of change in social relations. New acquaintances are not made, relationships are not maintained with all relatives and old friends.
6. Derealization and depersonalization. The patient left the house and got lost. It seemed to him that everything around him was somehow alien and unfamiliar. He perceives himself as if he were a different person. Sometimes the flow of thought stops and he finds himself in a mental void.

The fundamental criterion for diagnosis was the presence of delusions, hallucinations and pseudohallucinations. And we list what we have. Delirium of guilt, and even a naked girl on the roof asked to dance with her, voices in my head and the like. These are the main criteria by which the paranoid form of schizophrenia is identified in psychiatry.

The doctor indicates signs of schizophrenia in the medical history

It remains to substantiate the Kandinsky-Clerambault syndrome. It is indicated that the patient believes that his thoughts have become alien, they want to poison him. This shows the presence of mental automatisms and delusions of influence.

Well, we justify the paroxysmal-progressive course by the fact that there is an emotional-volitional defect that does not have remission, and against its background, episodes of schizophrenia constantly occur, which come with an increase in negative symptoms and the appearance of more vivid delirium.

The simplest form of schizophrenia is the most difficult to substantiate, since it is not associated with delusions and hallucinations and is identified mainly by serious behavioral negative symptoms. But try to immediately distinguish a slob and slob from a patient, and then also prove it competently and thoroughly.

Differential diagnosis

In this section of the medical history, the doctor writes that paranoid schizophrenia must be distinguished from other mental and nervous system disorders. Commonly mentioned are epilepsy and bipolar affective disorder, which many still call manic-depressive psychosis. The correctness of the diagnosis is proven by the presence of delusions, other pathogenesis and similar characteristic features of schizophrenia. The doctor emphasizes that these are not other diseases.

Treatment

If only medication was carried out, then they limit themselves to listing the drugs, but if there is some other therapy, then they write about it too. All types of medications are indicated:

• antipsychotic;
• antidepressant;
• drugs that improve sleep;
• neuromultivitis.

Of course, those that were prescribed and their dosage by day are written down. In the case we are looking at, most likely, there would be haloperidol and chlorprothixene. It is possible that in case of a severe form, injections would be given first, and then they would switch to tablets.

Expert review

The last section is “Expert Evaluation”, but it may not exist. This is not the conclusion of some kind of examination, but simply the doctor’s opinion about the situation. Three types of assessments are indicated:

• labor;
• forensic psychiatric;
• military

Of course, if the latter is required. Usually no one writes specifically about the patient. They say that in practice, in most cases, patients with one or another diagnosis are recognized as capable, sane, fit for service or, conversely, incompetent, insane and unfit.

The case history of “schizophrenia” in psychiatry itself is an internal document. Others are created on its basis, and it is also used when conducting examinations and at the time of writing an epicrisis or discharge epicrisis, as well as issuing various certificates.

A medical history is an internal document on the basis of which other documentation is completed

The form of the presentation of the medical history itself may be different. For example, some doctors write not only about prescribed drugs, but also their indications and contraindications, others provide the results of various tests. Not for paranoid schizophrenia or a simple form, of course, but for the state of memory, attention and the like.

Mental illnesses create a lot of problems for the patient and his loved ones, so it is important how accurate the diagnosis of “schizophrenia” is, how it is made and whether it is possible to remove the depressing inscription in the medical record.

Correct methods for diagnosing mental illness are the key to successful treatment. A professional attitude towards the disease requires long-term observation of the patient - at least 6 months in an inpatient psychiatric facility. The disease is serious and without proper treatment leads to irreversible processes. Moreover, a person suffering from mental disorders, at the moment of exacerbation, can become dangerous to himself and others. But you can’t immediately give up on a suffering person. Doctors often make mistakes, and this is understandable - the symptoms of a banal nervous disorder can mislead even an experienced specialist. Therefore, it is important to continue the examination, not read myths about the impossibility of recovery and carefully follow the doctor’s recommendations.

Important: with the right approach, over time the pressing question will become: “How to remove the diagnosis of schizophrenia and you can successfully forget about the illness and start living a normal life.

The diagnosis of schizophrenia can only be made by a qualified doctor

It is not so easy to identify the first signs, that is, the manifestation of the disease. Usually the symptoms are hidden behind sensations that are familiar to many: depression, irritability after stress. Also, the majority mistakenly believes that conditions such as fear, persecution mania and others are a sign of past illnesses, injuries, and conflicts. Therefore, they turn to doctors without missing the first point. But experts say one thing: even if you doubt that this is not a manifestation of schizophrenia, you should still go to the clinic.

Diagnosis of schizophrenia: who makes it?

There are different methods for determining mental illness, and only persons with higher medical education specializing in psychiatry treat patients of this type. The doctor must have a certificate. To find an experienced doctor, you need to find out about his activities through reviews from former patients. Ideally, a good doctor has his own official website, which displays all the information about his work, diagnostic methods, and treatment methods. An important component is the availability of work in well-known clinics, not only domestic, but also foreign.

Important: a self-respecting specialist always adheres to the confidentiality policy.

When visiting, the doctor conducts a visual examination. The second stage is communication with the patient. Thus, paying attention to the patient’s speech, his behavior, ability to answer certain specific questions, reason, construct sentences, the doctor draws certain conclusions. Then it is mandatory to have a conversation with the sick person’s relatives, who need to be told in detail about how he behaves, what symptoms are alarming and appearing. It is also necessary to identify whether there are other family members who exhibit inappropriate behavior, oddities, speech disorders, etc.

How to diagnose schizophrenia

Some people mistakenly believe that mental disorders can be determined by consulting with a doctor via Skype or in absentia. For an accurate diagnosis and identification of all signs of the disease, an in-person consultation is necessary. The main symptoms include:

• inappropriate behavior;
• impoverishment of speech, incoherence, loss of logic;
• inhibition when thinking, inability to clearly express one’s thoughts;
• loss of logic in reasoning;
• feeling of fear, delusions of persecution, grandeur;
• autism is a closure in one’s own limited world.

If at least two of the listed signs are present, and they are observed for more than 2 months, a trip to a psychiatrist is mandatory. The list of mandatory diagnostic methods includes a test that detects mental disorders.

Diagnosis of schizophrenia involves passing a special test

Test questions

1. Does the patient read other people’s thoughts or express his own out loud?
2. I am sure that the thoughts are imposed from the outside.
3. Someone controls feelings and movements.
4. Delusional ideas and hallucinations arise that are considered incredible from the point of view of common sense. That is, the patient can be confident in his exclusivity and believe that he has special abilities.
5. Incoherent speech, fragmented thoughts, neologisms.
6. Catatonic seizures: the patient’s refusal to communicate, perform tasks, reluctance to answer questions, freezing in a certain, strange position or complete inhibition - stupor.
7. Behavioral disorders: lack of any interests, desire to do what you love, abandonment of goals, withdrawal from society.
8. Loss of emotions, complete indifference to reality, lack of social contacts.

Additional diagnostic methods

Mental disorders, fortunately, are not a common disease. Very often, ordinary people confuse banal depression, stress, fatigue, and adolescence with schizophrenia. It is for this reason that there is a differentiated method for determining the disease, in which all of the listed symptoms are excluded, as well as exogenous signs associated with the consumption of alcohol, drugs, brain diseases, and poisoning. When diagnosing, blood and urine tests are required to identify pathologies that affect the patient’s psyche.

Important: after treatment, as a rule, the diagnosis of schizophrenia is removed and the patient returns to a normal lifestyle. Subsequently, periodic visits to the doctor will be required to determine relapses or establish stable remission.

Diagnosis of schizophrenia: how to remove it

An accurate diagnosis of a mental disorder requires powerful interventions using a variety of methods. Modern psychiatry has a number of excellent neuroleptics and nootropics, thanks to which there is a specific answer to the pressing question - “Is it possible to remove the diagnosis?” - yes, it’s possible. The following medicines are effective:

• quetiapine;
• phenazepam;
• cyclodol;
• rispolept;
• haloperidol;
• clozapine;
• promazine, etc.
• Insulin coma. When a certain dose of the drug is administered, the patient’s disease progression is inhibited. Depending on the phase and form of the disease, the doctor prescribes the time and dose of insulin. The procedure is carried out only in a hospital hospital setting and under the strict supervision of medical staff and the attending physician.
• Stem cells. Thanks to the innovations of modern specialists, it was possible not only to induce stable remission, but also to cure mental illness. Immature cells in the human body are capable of acquiring the functions and forms of the organs next to which they are located. But they do not contain pathologies that cause disease.

Stem cell treatment is often practiced to remove the diagnosis of schizophrenia.

A stir in psychiatry was caused by the discovery of gene therapy by scientists from an Irish university. Judging by their beliefs, schizophrenia is caused by the combination of only 4 types of genes, if you eliminate this problem, you can remove the diagnosis of “schizophrenia” and forget not only about mental disorders, but also epilepsy, depression and other ailments associated with impaired brain function .

How to remove the diagnosis of schizophrenia from a psychiatrist

In order to no longer have an unpleasant diagnosis in your medical record, you need to be patient and go through certain stages. First of all, a psychiatrist observes the patient for 5 years. In this case, the patient should not have a relapse and remain in stable remission. The complete absence of mental disorders requiring treatment, hospital stay and medication is taken into account.

To remove the diagnosis of “schizotypal disorder”, you need to submit an application to the psychoneurological dispensary addressed to the chief physician and undergo an examination. It is necessary to hospitalize the patient for a period of 2 to 3 weeks without prescribing medication. Testing and methods for differential diagnosis of the condition are carried out, after which the diagnosis is removed or not.

How to remove the diagnosis of “schizotypal disorder” without the consent of the attending physician? In cases where the subject does not agree with the psychiatrist’s conclusions, it is possible to file a claim in court and undergo additional examination with re-examination. Additionally, a commission of other specialists in psychiatry works and a conclusion is written, which is sent to the PND at the patient’s place of residence (registration).

Schizophrenics tend to suffer from multiple personality disorder

I was diagnosed with schizophrenia - how to move on?

The disease is not scary, as it is portrayed by ordinary people and amateurs who do not understand much about medicine. It is because of them that the life of a sick person changes for the worse. Mental anguish and complete disappointment also torment the patient’s loved ones. There is a term “self-stigmatization”, in which a person learns about his illness and puts a “fat cross” on the future. Unfortunately, suicidal acts are often committed. We invite you to familiarize yourself with myths that are easily debunked:

• Schizophrenia is a severe form of mental illness. The disease is a mysterious type of disease and most doctors have not yet decided whether it is a condition or a disease. But by consulting a doctor in time, you can quickly return to normal and continue a quality existence.
• All schizophrenics suffer from a split personality. This symptom in rare cases accompanies the disease. If it does arise, it is not necessary that the person will behave aggressively; more often, stable positive actions towards others arise, and they manifest themselves in a mild form.
• A sick person will definitely become weak-minded. With timely treatment, no serious consequences will occur. On the contrary, it is possible to concentrate internal potential and develop special abilities.

Important: among former PND patients there are often musicians, artists, designers, mathematicians, chess players, etc.

• Schizophrenia is a socially dangerous disease. Firstly, the disease is not at all contagious. Even the genetic nature of mental disorders is questioned by most experts. Secondly, aggressive people are rarely found among patients, and if adequate therapy has been completed, then you don’t have to think about problems. Among healthy members of society, there are many more individuals with aggression, anger and misconduct.
• The disease is incurable. According to researchers, in about a quarter of cases, patients experience only one mental breakdown without relapse. Only a small proportion of patients suffer from the disease in later life, and only if treatment is refused.
• In case of mental illness, the patient will be admitted to a clinic for the rest of his life. Doctors do not need to keep a healthy person in the hospital whose condition has been cured in a short period. It is enough to continue to be observed by a doctor and follow the recommendations of a specialist.

Schizophrenia is considered a socially dangerous disease

Nowadays, diseases of any complexity can be cured, and if a very complex form has arisen, then there are additional, more radical methods of treatment. The problem also lies in the fact that after diagnosis, the patient withdraws into himself and refuses to communicate with others, which aggravates the condition. The main thing is not to panic, to take adequate measures in time with an experienced doctor. The success of treating mental pathologies directly depends on the mood of the patient and his family, which has been proven many times by official medicine.

Even the first stage of schizophrenia can look like a completely frightening condition for others, let alone deeper conditions. However, it is not at all necessary that the life of the patient, relatives, and acquaintances be completely ruined. The use of medication, therapy and support allows many people with schizophrenia to control their symptoms, have greater independence and lead fulfilling lives. This article explains the main types of schizophrenia and may help you understand the symptoms of the mental disorder.

Five main types of schizophrenia

Early diagnosis and treatment can prevent many unnecessary complications and improve the chances of recovery, so if you are worried that you or someone you know is experiencing episodes of schizophrenia, do not hesitate to seek professional help. Recovering from the disease of schizophrenia will not happen overnight. Finding the right treatment takes a long time and, of course, there are failures along the way. Of course, it is unlikely that schizophrenia can be cured completely, but in fact, over time, most people with this disease get better. Therefore, no matter what challenges are currently faced, there is always hope. To understand the prospects for treatment, it is necessary to understand what the types of schizophrenia are.

Paranoid schizophrenia

Modern psychiatry suggests that paranoid schizophrenia is the most common type of illness. It is a subtype of schizophrenia in which the patient has illusions (false assumptions) that a person or some people are plotting some kind of crime against him or their family members.

Most people with paranoid schizophrenia, as with most schizophrenic subtypes, may also have auditory hallucinations - they hear things that are not real. They may also suffer from delusions of grandeur, which is the false belief that they are much more powerful than they actually are. Schizophrenia and its paranoid form forces the patient to spend a disproportionate amount of time coming up with ways to protect themselves from an imaginary attack. People with this mental disorder have fewer memory problems and are not as dulled in their emotions and concentration compared to other subtypes. However, paranoid schizophrenia is a chronic (long-term, lifelong) condition that can eventually lead to to complications, including suicidal thoughts and behavior. With proper treatment and support, patients have a very good chance of leading happy and fulfilling lives.

We talk in more detail about what paranoid schizophrenia is and the prognosis for its treatment in a separate article.

Disorganized type

This type of schizophrenia (formerly called hebephrenic schizophrenia) is marked by disorganized speech, thinking, and behavior on the part of the patient, coupled with a flat or inappropriate emotional response to the situation (affect). The patient may act stupidly or extremely antisocial. Most patients in this category had a weak personality structure prior to their initial acute psychotic episode.

Catholic type

Catatonic schizophrenia is characterized by severe psychomotor impairment, which may include immobility (stupor or catalepsy), excessive motor activity, extreme negativism, mutism, echolalia, echopraxia, and peculiar voluntary movements such as posing, mannerisms, grimaces, or stereotypic behaviors.

Undifferentiated type

Patients in this subtype of schizophrenia have the characteristic positive and negative symptoms of schizophrenia, but do not meet specific criteria for the paranoid, disorganized, or catatonic subtypes.

Residual type

This category is used for patients who have had at least one acute schizophrenic episode but do not currently have severe positive psychotic symptoms such as delusions and hallucinations. They may have negative symptoms, such as withdrawal from others, as well as mild forms of positive symptoms, which indicate that the disorder has not been completely resolved.

It has been proven that schizophrenia and heredity have a direct relationship. The risk of schizophrenia among first-degree relatives of biological relatives is ten times greater than that observed in the general population. In addition, the presence of the same disorder is higher especially if it is schizophrenia in monozygotic twins (identical twins) than in dizygotic twins (non-identical twins). Research on identical twins also supports the idea that environmental factors are important because not all relatives who have the disorder pass it on. There are chromosomes and loci (specific regions on chromosomes that contain mutated genes) that have been identified. Research is actively ongoing to clarify the causes, types and variations of these mutations.

Latent schizophrenia and other types of illness

Latent schizophrenia is an old term for a type of illness that is characterized by clear symptoms of schizophrenia, but without a history of a psychotic schizophrenic episode. These are not the usual schizophrenic patients that you can watch on the video on yotobe - in fact, you may not notice anything unusual - it includes conditions that are called the initial prepsychotic, prodromal, pseudoerotic stage of schizophrenia. Often, schizoid personality disorder and schizotypal personality disorder in latent forms of the disease are almost impossible to quickly detect. .

At the same time, latent schizophrenia is characterized by a total feeling of anxiety and a wide variety of neurotic symptoms, which initially mask the main psychotic tendencies, which can manifest themselves as random, brief psychotic episodes. These are generally considered to be serious disorders.
But even with latent schizophrenia, antisocial, impulsive, or sociopathic tendencies already appear, which initially mask the underlying psychotic tendencies characteristic of schizophrenia.

In general, a simple form of schizophrenia is characterized by a gradual loss of sense of support, social isolation, and emotional apathy, but without prominent psychotic signs. It is often mistaken for a form of personality disorder.

So-called bipolar schizophrenia

Bipolar disorder is a psychiatric illness characterized by episodes of "mania." Symptoms include euphoria, distractibility, irritability, and grandiosity. During a manic episode, people often have remarkable energy and movement, vivid thoughts, and rapid speech. They sleep little, but do not seem to get tired at all. maybe tired. They may also experience illusions, such as believing they are able to fly or walk on water like Jesus. They may suspect that people around them are trying to harm them. During a manic episode, some people hear voices or experience visions. Severe depressive episodes are also often part of bipolar disorder.

But still, such a similar disease as schizophrenia is a much larger personality change, so Western psychiatrists do not diagnose bipolar schizophrenia in a number of similar, but not so significant, manifestations of symptoms. Schizophrenia is characterized by a group of so-called “positive” symptoms that may include hallucinations (hearing voices, visions), delusions (fixed false assumptions), and/or mental disturbances (speaking that does not make sense). Words are spoken, but the connections between sentences are illogical. (This is called formal thought disorder.) In addition, people with schizophrenia often exhibit "negative" symptoms, where they become interested in interacting with other people but lose the ability to enjoy previously performed activities, talk less, and exhibit behaviors that are quite flat, without much expressiveness.

Psychiatrists often see a range of symptoms, so it can be difficult for them to determine whether a person has schizophrenia or bipolar disorder - even after years of observation. Therefore, patients receive the diagnostic label schizoaffective bipolar type.

Split personality and schizophrenia

The term schizophrenia is commonly misinterpreted to mean that the person suffering from the disorder has a "multiple personality disorder." Although some people diagnosed with schizophrenia may hear voices, modern psychiatry is confident that schizophrenia and multiple personality disorder are not the same thing. The confusion arises in part because of Bleuler's meaning of the term schizophrenia (literally, "split" or "destroyed mind"). The first known fact of abuse of the term to designate “split personality” was noted in an article by the poet T.S. Eliot in 1933.

Prognosis for treatment of schizophrenia

One of the important prognostic signs of treatment for schizophrenia is the patient’s age at the onset of the disease and the manifestation of psychotic symptoms. Early-onset patients with latent schizophrenia and its symptoms are more likely to be male, have lower levels of pre-illness functioning, higher rates of brain abnormalities, more prominent negative symptoms, and, as a result, poorer outcomes. Late-onset patients are more likely to be female and have fewer brain abnormalities, leading to a better prognosis.

The average outcome for schizophrenics is less favorable than for most other mental disorders, although 30% of patients diagnosed with schizophrenia recover completely or have significant improvements. Two factors that influence outcomes are stressful life events and a hostile or emotionally charged family environment. Schizophrenics with many stressful changes in their lives, as well as those who are exposed to frequent contact with emotionally oriented family members, are more likely to relapse.