Schizophrenia: types, forms and manifestations

Schizophrenia is the most mysterious and little-studied mental illness, although medical scientists have been studying it for a very long time. It is a complex personality disorder characterized by multiple manifestations. The life of a person suffering from this disease is divided into two realities: objective and his own, in which only he, his fears, thoughts, experiences exist. A person with schizophrenia loses control over his emotions, behaves instinctively and unpredictably.

The disorder can have various types and manifestations. Often its symptoms can be similar to other mental illnesses. The severity, as well as the course of the disease, are purely individual, but are determined by hereditary and acquired factors.

Origin of the disease

Schizophrenia is a multifactorial disorder. This means that it can develop either as a result of one reason or a combination of them. The greatest risk group is represented by hereditary predisposition. If one of the relatives, even not very close ones, suffered from this mental illness, then the chance of its occurrence in descendants increases significantly.

Triggers for the onset of the disease are some external factors. The development of the disease can be triggered by:

• severe stress, most often caused by the loss of a loved one;
• experience, both negative and positive;
• features of the educational process (bullying, expressiveness, physical or psychological violence, cruelty);
• low social status, oppression, discrimination;
• infectious and viral diseases suffered by the expectant mother during pregnancy;
• low self-esteem, congenital lack of self-confidence;
• brain injury;
• consumption of alcohol and drugs.

This is a fairly common disease, affecting more than 24 million people worldwide (only officially identified cases). It can begin to progress at any age, but the sooner this happens, the greater the likelihood that the consequences will be irreversible.

Symptoms

Manifestations of schizophrenia can be divided into two categories: positive and negative. At the same time, positive symptoms do not mean anything good. In this case we are talking about acquired productive indicators:

• hallucinations;
• delusional ideas;
• increased agitation, nervous tension;
• thinking disorders;
• disturbances of personal perception.

Negative symptoms indicate personality degradation, loss of once-existing qualities. They are expressed by the poverty of emotional reactions, the loss of any abilities, for example, the inability to experience joy, pity, sympathy.

Often there are severe depressive moods combined with depression, loss of courage and hope. This is expressed as follows:

• ennui;
• increased fatigue for no apparent reason;
• apathy;
• depression;
• reduction of contacts;
• impaired concentration;
• inhibition of speech, facial expressions, gestures;
• noticeable decrease in attention and memory.

Violations of motivation and social behavior are very common. A person becomes indifferent, loses energy, withdraws into his own world, which can result in social isolation. Along with this, excessive suspiciousness and suspiciousness, inadequate reactions to situations, and difficulties in formulating thoughts may develop.

The progression of schizophrenia leads to an emotional-volitional defect. It is characterized by a lack of volitional manifestations and indifference to the surrounding world. Ordinary daily activities, such as going to the store, preparing dinner, washing your hair or brushing your teeth, are practically a feat for the patient.

Rave

This is one of the main symptoms of schizophrenia. Depending on the type and form of the disease, psychiatrists identify delusions in the following areas:

• stalking – the patient’s confidence that someone is watching him;
• relationships - a strong belief that all events that occur are not accidental and are directly related to the schizophrenic;
• influence - it seems to a person that the thoughts in his head do not actually belong to him, but are imposed by someone from the outside, and he cannot control them on his own;
• damage – the patient suspects close relatives, neighbors and other people of damage to property or theft of personal belongings;
• hypochondriacal - attributing to oneself a non-existent serious illness, a tireless search for symptoms confirming this version;
• of special significance - confidence in one’s own unique abilities, confidence in one’s originality, greatness or unique mission for all humanity.

At the initial stages of the development of schizophrenia, delusional ideas and plots do not yet fully manifest themselves, but the person suffering from the disorder already feels some kind of oppressive tension around him. He experiences anxiety, restlessness, and lack of understanding of current events, often accompanied by insomnia.

Next comes the stage of crystallization of delirium. The patient calms down, anxiety disappears, and is replaced by an understanding of what is happening. But all events are now interpreted according to the plot of delirium. A schizophrenic finds an explanation for the smallest details and details, suspects a threat to himself in everything that happens.

Over time, delusional ideas become systematized: a person connects events from the past and present, and finds signs in them. He builds such logical chains, suspecting everyone and everyone separately, of crimes known to him alone, that the most successful investigator would envy.

The development of delusions can have two scenarios:

1. Acute phase. With this course of the disorder, the patient’s behavior attracts the attention of others. In some cases, he is even dangerous to society. To some extent, this is a positive sign - it is simply impossible not to notice such changes in behavior. This means that a visit to the doctor will follow and productive treatment will begin.
2. Regularly occurring manifestations. The disease develops according to this type in people with a more stable psyche. They find some logical explanations for their own delusional ideas and behave relatively adequately than in the first case. This fact makes it possible to hide the disease for a long time and identify schizophrenia in the later stages, when the personality defect is practically formed and irreversible.

People suffering from schizophrenia have different attitudes towards their own delusions. Some resist obsessive thoughts with all their might, demonstrating inappropriate behavior. Others use the “giving in” method and try to shift their attention as soon as delusional ideas begin to overcome them.

Immersed in their own reality, patients gradually lose contact with the outside world. Against the background of autistic isolation, a fading of emotions is observed. Previous interests become irrelevant, the feeling of attachment to loved ones is lost, and the emotional acuity of perception is erased. Schizophrenics are indifferent to their natural needs and appearance.

Hallucinations

A hallucination is a false perception of reality, a sensory impression that occurs without a corresponding external stimulus. The patient may see, hear, feel or smell things that are not there. Most often, people suffering from schizophrenia experience auditory hallucinations.

A classic example of auditory hallucinations is a voice in the head. It is present in everyone, and this is a normal phenomenon - this is how a person thinks. But in a patient with schizophrenia, this voice is foreign in nature, he is not able to control it.

Voices in your head (there may be several of them) comment and give advice. Often a schizophrenic can hear them discussing him in the third person, he tries to justify or resist them, doing it out loud or in the presence of other people. The most dangerous, according to psychiatrists, are considered imperative - commanding voices. Under their influence, the patient may commit wrong actions, crimes or suicidal actions.

Hallucinations can be visual or tactile, but they are not as common as auditory ones. Such manifestations are sometimes so real and connected with real events that a person does not even suspect that he is in the grip of an illusion.

Types of schizophrenia and their symptoms

The clinical picture of the disease directly depends on its form. Among the most common and well-known forms are paranoid schizophrenia , the main manifestations of which are delusions and hallucinations. The hebephrenic form is characterized by foolishness, relapse into childhood, elevated mood, and pretentious behavior. Catatonic schizophrenia is an alternation of two phases of psychomotor disorders: stupor and agitation.

Another common type of illness is simple schizophrenia . Her picture is dominated by negative symptoms, and productive symptoms are not found.

But, along with the listed forms, there are others. They are less known, but have their own characteristic differences.

For example, there is senestopathic schizophrenia , which is based on the appearance of senestopathies. These are unpleasant, exhausting sensations in the body that have no clear localization and no real cause.

The paranoid form is accompanied by the development of delusions of several types at once: jealousy, grandeur, persecution, etc. It grows over several weeks, or even months, and can persist for up to several years. There are no hallucinations in this form. It is interesting that most often arrogant, suspicious people who seek truth and justice are susceptible to its development. This type of disease is dangerous because it sometimes pushes patients to commit crimes.

Neurosis-like schizophrenia by hypochondriacal and obsessive thoughts. Obsessions often manifest themselves in the form of fears, and they are quite ridiculous. For example, fear of a certain word. Hypochondriacs complain of unusual sensations in the body: a snake lives in the throat, curled up into a ball, and makes it difficult to swallow. They may find non-existent deformities in themselves and try to correct them with improvised means.

The schizoid form is the lot of school age people. Such children lose contact with their peers because they consider them a threat to themselves. Because of this, they become withdrawn and keep to themselves. Subsequently, fear reaches universal proportions, and the patient is afraid of the whole world as a whole. In this case, he is able to bring himself to complete isolation, fear of leaving the house.

Acute polymorphic schizophrenia develops instantly, within a couple of days. Sharp mood swings appear: from crying and panic to euphoria and aggression. Situational delirium is possible: someone fixed their gaze on the patient - it means that he is a spy, and is called upon to keep an eye on him.

Schizophrenia is a disorder with a wide range of symptoms. Despite the fact that it leaves an imprint on consciousness and mental activity, many patients function quite tolerably in society and live in harmony with their illness. However, the other part undergoes significant destructive changes that completely “transform” such patients. This category includes disorganized and febrile forms of the disorder.

Disorganized schizophrenia

Patients in this category are characterized by complete collapse of personality, degradation and disappearance as a functioning subject of society.

The disease is characterized by pathological changes in all areas: behavior, emotions, thinking.

A person with a disorganized form of schizophrenia behaves inappropriately. But this inadequacy manifests itself in different directions. On the one hand, this is unmotivated aggression, hot temper, threatening the lives of people around. Often such subjects become participants in conflicts or criminal acts.

On the other hand, this form of the disease can manifest itself as increased mood, foolishness, groundless giggling, and euphoria. Patients grimace, laugh, smile.

Whatever the form of behavioral imbalance, it is characterized by the inability to care for oneself, study, engage in professional activities, or generally engage in any purposeful activity. The patient simply cannot brush his teeth or take a shower, or dress according to the season: in the heat he goes outside in a jacket.

To imagine the situation, you can remember the movie “Pet Detective”. The episode when Ace Ventura, in the course of his investigation, visits a psychiatric hospital and imitates a mentally ill person dancing in a ballerina's tutu, quite accurately conveys the essence of the clinical picture of the disease.

As for emotional reactions, the range here is also vague: from complete apathy, when the patient lacks the slightest facial expressions and gestures, the face is stony, the posture is frozen, unchanging, to unbridled joy. Illogical emotional responses are characteristic, for example, laughter in tragic moments.

The speech of such people is incoherent, does not have a clear direction and meaning, in their narration they jump from one topic to another. Thinking is torn, deprived of the ability to analyze or plan anything.

It is not uncommon for patients to experience hallucinations and delusions.

Naturally, all these destructive changes leave their mark on the connection with society. A person becomes isolated from others, may fall into severe depression, or commit suicide. It happens that patients become dependent on alcohol and drugs.

This form of the disease is scary because patients do not know what they are doing and how they become dangerous to society. They do not admit their illness and categorically refuse treatment.

Associated syndromes

In addition to the presence of typical symptoms of the disease, patients with schizophrenia are characterized by manifestations of various syndromes and obsessive mental states. The following deviations can be observed:

1. Capgras syndrome. The patient is convinced that he himself or one of his relatives or friends is periodically replaced by a double. Accordingly, all bad deeds are committed by this same double.
2. Ekbom syndrome. The patient is sure that some kind of parasitic insects live under his skin or in his internal organs. He never tires of telling and showing this to everyone, although the statements may not correspond to the elementary structure of the human body.
3. Lycanthropy. From time to time an individual feels like he is a wolf. As long as the patient feels like a human being, he can be absolutely adequate and completely sane. However, as soon as he “becomes a beast,” everything changes radically - his behavior poses a danger to others. Patients with this type of disorder often howl, bark, crawl on all fours, and attack others.
4. Kandinsky-Clerambault syndrome. It is characterized by delusions of influence and persecution combined with pseudohallucinations. Those suffering from this syndrome consider themselves to be victims of witchcraft, radiation, or believe that their thoughts are in the public domain.
5. Cotard's syndrome. This is the opposite form of megalomania. It is manifested by inadequate formation of reality, perception of oneself as a nonentity, self-flagellation and taking responsibility for all world cataclysms and crimes. The patient thinks that he died a long time ago or that he has no internal organs.

Clinical forms and types of schizophrenia

Schizophrenia, depending on the type and form of the disease, may have the following clinical manifestations, which are the main ones:

• continuous. Continuous or sluggish schizophrenia is a mental disorder whose symptoms are mild, but make themselves felt constantly. A person with this form of the disease, with properly selected therapy, can live a fairly long life without losing its quality (family, work, etc.);
• paroxysmal schizophrenia, also called fur-like schizophrenia. It has nothing to do with outerwear, but comes from the German word schub - “attack”. The prognosis of the disease is not good, since with each exacerbation (even when receiving therapy), the disease takes over larger and larger areas of the brain. With the next attack, less and less of the patient’s personality remains; delirium completely takes over the person, and he slides into dementia. This form of schizophrenia with an episodic type of course with an increasing defect is known in the medical literature as paroxysmal-progressive;
• periodic or recurrent schizophrenia. Acute attacks occur sporadically. They are usually accompanied by delusions, hallucinations and disturbances of consciousness. Then an improvement occurs, how long it will last is unknown. The disease may not make itself felt for years or even decades;
• malignant (also severe and continuously ongoing or continuously progressive). This type of course of the disease does not imply any clear intervals, only one continuous attack without clearing or improvement;
• low-progressive. The disease progresses slowly, periodically, with mild symptoms. People with this type of schizophrenia can hide their mental disorder for quite a long time. This fact poses the greatest danger, since without appropriate treatment it can quickly become severe.

Simple

This form of schizophrenia begins in adolescence and sometimes childhood. Productive symptoms are either absent or mildly expressed. The patient very quickly develops cognitive impairments, which negate educational, work and any useful activities. The range of interests extends only to satisfying one’s own needs.

The simple form is characterized by the following personality disorders:

• progressive impoverishment of emotions;
• intellectual unproductivity;
• loss of interests;
• increasing lethargy, isolation;
• rudimentary nature of positive psychotic factors.

The patient loses contact with loved ones and develops a tendency toward vagrancy and antisocial behavior. Such individuals do not show interest in others and their own fate. Gradually they lose previously acquired skills, sinking to the bottom of social life.

Paranoid

The most common type of disease, characterized by absurd, fantastic delusions of persecution. It is with him that pronounced expansive experiences are associated: from ecstatic delight to mortal horror. The patient never tires of coming up with various crazy ideas, believes in them himself, talks about them to others and tries with all his might to implement them in life.

Hallucinations are so pronounced that they completely absorb a person’s consciousness - he has no doubt that the events taking place are real. The patient experiences a surge of various emotions, but a manic or depressive factor may predominate. Thinking and logical perception are very quickly deformed. Grossly inappropriate behavior, motivated by aggressiveness or imperative hallucinations, predominates. Forced hospitalization becomes inevitable.

Paranoid schizophrenia begins to progress in more or less adulthood. This usually happens after 20 years and does not depend on gender.

Catatonia

A severe form of schizophrenia, fortunately, is currently not as common as, for example, in the middle of the last century. For this type of mental disorder the following are typical:

1. Catatonic excitement - the individual shows negativism and does not find a place for himself. Aimless and meaningless movements are stereotypically repeated. Trying to stop the patient does not have a positive result, but only aggravates the situation. Excitement intensifies and can cause counteraction with a demonstration of aggression.
2. Catatonic stupor - a person freezes in the position in which he was at the moment when the attack occurred. This position can be very uncomfortable, but the patient is not able to correct anything. The muscles seem to freeze; such a stupor can last from several minutes to several days. The attack is accompanied by mutism - complete silence, as well as extreme tension in all the muscles of the body or waxy flexibility. During this period, a person is unable to eat on his own; the feeding process is carried out through a tube. Natural physiological needs cope with themselves. There is no clouding of consciousness during such an attack. Having come out of the stupor, the patient can talk about all the events and actions that were happening around him at that time.

Hebephrenia

The main symptom of hebephrenic schizophrenia is inappropriate, defiant behavior. The person behaves like a bad actor playing a capricious child. It has the following manifestations:

• ridiculous foolishness;
• gross antics;
• use of obscene language;
• using obscene jokes;
• exaggerated grimaces;
• emphasized hypersexuality.

Such inexplicable fun frightens and burdens others. The conversation is conducted in an unnatural voice - a pathetic tone or lisp, while sophisticatedly distorting the words. Delusional ideas and hallucinations appear fragmentarily and episodically.

The hebephrenic type disorder makes itself felt from the age of 15–17 years. The prognosis is most often unfavorable. The disease develops very rapidly - a defect in emotional and volitional qualities occurs within 1–2 years.

Thinking disorders in schizophrenia.

Home Favorites Random article Educational New additions Feedback FAQ

⇐ PreviousPage 7 of 15Next ⇒

The clinical literature on schizophrenia describes in detail features that include a range of cognitive and emotional dysfunctions. However, none of the disorders is pathognomic for schizophrenia when isolated. The diagnosis of this disease involves recognition of a constellation of signs and symptoms associated with impaired social and occupational functioning. E. Bleuler considered disorganized thinking in terms of weakening associations to be the most important sign of the schizophrenic process. Assessing disorganized (illogical) thinking can be accompanied by a number of difficulties. “Mild” speech disorganization is not necessarily associated with schizophrenia. Speech disorganization is correlated with schizophrenia when it is pronounced and interferes with social adaptation. The main disorders of thinking are (according to E. Bleuler): fragmentation, ambivalence and autism. Additional symptoms include delusions, hallucinations, and catatonic disorders. The thinking of patients is incoherent and illogical, depending on the stage and course of the disease. In cases of deep defect, speech takes on the character of “verbal hash.” Quite often there is a syndrome of “made thoughts” imposed by someone “forcibly”, which is Kandinsky’s syndrome - clerambault. The opposite (but within the framework of the same Kandinsky syndrome) is “taking away thoughts”, thoughts are taken away from patients by someone from the outside. The collapse of concepts in schizophrenia is expressed in the fact that concepts lose their precise meanings and clear distinctions from other concepts. The following thinking disorders occur in schizophrenia:

Sperrung - “blockage of thoughts”, “break of thoughts”, sudden stop, interruption of the associative process.

Discontinuity is a thinking disorder in which the logical connection in a sentence is disrupted while the grammatical connection is preserved (in speech it manifests itself as schizophasia).

Slipping is a thought disorder (a “milder” degree of disruption).

Incoherence is a thinking disorder in which logical and grammatical connections in sentences are disrupted.

Diversity is a thinking disorder in which judgments are formed based on different principles.

Reasoning is “fruitless philosophizing” (reasoning for the sake of reasoning).

Thinking disorders in bipolar affective disorder.

In bipolar affective disorder, the first thing that suffers is the pace of thinking. During a depressive episode, thinking slows down. This is manifested by a decrease in the number of associations per unit of time. With manic syndrome, the number of associations per unit of time increases, that is, thinking accelerates, up to a “leap of ideas,” that is, a maximum increase in associations per unit of time.

Characteristics of obsessive, overvalued and delusional ideas.

Thinking disorders in terms of productivity are the most striking and common signs of mental illness. These include obsessive, overvalued (dominant) and delusional ideas.

Obsessive ideas are thoughts, ideas, memories that arise against the will of the patient with a full critical assessment of foreignness and pain. These forms of thinking disorders manifest themselves in neurotic and neurosis-like disorders, as well as in personality disorders and character accentuations of the psychoasthenic type.

Overvalued ideas are ideas that arise in connection with a real situation, but subsequently occupy a dominant position in the patient’s mind that does not correspond to their actual meaning, accompanied by significant emotional stress and a lack of a critical attitude towards them. They appear in personality disorders and schizophrenia.

Delusional ideas are judgments and conclusions that have the nature of conviction, arise on a pathological basis and cannot be corrected (dissuaded) with a lack of a critical attitude towards them.

There are two types of delusional ideas, differing in the mechanisms of delusion formation: interpretative delusion and figurative delusion (Table No. 4). In the first, pathological ideas (judgments and conclusions) arise as a result of violations of logic at all stages of delusional formation; in the second case, delusion stems from perception disorders (pathological images and ideas). Delirium, always a characteristic of psychosis, is most clearly represented in the clinic of schizophrenia.

Table No. 4 Forms of delirium

INTERPRETATIVE	FIGURATIVE
Relationships persecution physical impact greatness damage jealousy hypochondriacal inventions, discoveries reformation love, erotic litigious, querulyant high origin obsession dysmorphomaniac	relations of persecution greatness self-accusation, self-abasement hypochondriacal nihilistic denial metamorphosis (intermetamorphosis) obsession religious

Thinking disorders in organic disorders.

Decrease in the level of generalization: A decrease in the level of generalization consists in the fact that direct ideas about objects and phenomena dominate in the judgments of patients; Operating with general features is replaced by establishing purely specific connections between objects. When performing an experimental task, such patients are not able to select from among all possible signs those that most fully reveal the concept. So, for example, in an experiment using the classification method* one of these patients refuses to combine a cat and a dog into one group, “because they are at enmity”; another patient does not unite the fox and the beetle, because “the fox lives in the forest, but the beetle flies.” The particular signs “lives in the forest”, “flies” determine the patient’s judgment more than the general sign “animals”. Clinically, this is manifested by a tendency to concretize thinking. Concreteness is a thinking disorder in which the ability to abstract is lost.

The inability to complete a task in a generalized manner, the inability to distract from individual specific properties of objects are associated with the fact that patients cannot learn the conventions hidden in the task.

This misunderstanding of convention is especially clear when subjects interpret proverbs and metaphors.

As you know, proverbs are a genre of folklore in which a generalization and judgment are conveyed through the depiction of an individual fact or phenomenon of a specific situation. The true meaning of a proverb only becomes clear when a person is distracted from those specific facts that are spoken of in the proverb, when specific individual phenomena acquire the character of a generalization. Only under this condition is the content of the proverb situation transferred to similar situations. Such a transfer is similar in its mechanisms to the transfer of a method for solving one problem to another, which is especially clear when classifying phrases as proverbs. Considering the problem of transfer, S. L. Rubinstein o.

Emotional disorders

Emotions are mental processes and states in the form of direct experience of phenomena and situations affecting an individual. The emergence of emotions occurs either as a result of the satisfaction or dissatisfaction of any human needs, or in connection with the discrepancy between expected and real events, as well as the presence of maladaptive irrational cognitions. In recent years, they have preferred to use a narrow concept of emotions, which divides emotions into components of subjective experience, such as, for example, a) an affective component (emotions as such), b) a cognitive component (maladaptive cognitions, for example, inadequate concern about the state of their figure in women with nervous anorexia). .

In cognitive theories of emotion, it is argued that emotions are not caused by the perception of a situation directly, but that a cognitive appraisal of things must first occur. But it is also necessary to recognize the role of non-reflexive forms of emotion.

1. Innate emergence of emotions controlled by perception. Congenital forms of emotion formation are important primarily in the early periods of ontogenesis. Moreover, certain stimuli are genetically associated with certain emotions (for example, fear in depth perception). But genetically determined elements can also play a role in the emergence of complex emotions later in life. This is true, for example, for the supposedly genetically determined readiness of people for phobias regarding certain classes of objects (snakes, spiders).

2. Perceptually driven emergence of emotions based on early conditioning. That is, emotions caused by early traumatic experiences, as a rule, this traumatic experience is repressed from memory. [Jakobs, Nadel 1985].

3. The habitual occurrence of emotions, controlled by perception. Some “everyday” emotions and affects can arise as if out of “habit,” that is, the type of response is fixed conditionally reflexively. .

⇐ Previous7Next ⇒

Disease detection

Any type of schizophrenia, regardless of type and form, requires a correct, qualified, and most importantly, timely approach.

This disease does not develop overnight, like the flu or a cold; the first signs of the disorder become noticeable in childhood. Usually these are very “comfortable children”; parents cannot get enough of them. They:

• can play independently for hours without attracting attention;
• invent games on their own, do not need company;
• treat peers coldly;
• do not make a mess in the apartment;
• They don’t pester adults with a million questions per minute.

During adolescence, a teenager's body experiences a hormonal surge. Problems arise one after another: conflicts with parents, difficulties with school, difficult relationships with peers, thoughts of suicide, running away from home, etc. Relatives attribute all behavioral features to a difficult age, the vulnerable psyche of their child, or look for the reason in themselves, attributing some kind of upbringing mistakes.

The general picture of a mental disorder is formed by the age of 20–25, sometimes even earlier. At this age, productive symptoms (delusions, hallucinations) can no longer be hidden from others. The person ends up in a psychiatric ward, where the obvious diagnosis is confirmed.

Medical educational literature

The difficulties in diagnosing schizophrenia are not explained by the lack of precise knowledge of its etiology, but relate to the clinical side of its theory. One of the central points of the clinical side of the problem of schizophrenia is the question of the presence or absence of schizophrenic symptoms themselves. Clinical experience and strict psychopathological analysis of mental disorders in schizophrenia show that there are specific disturbances in various aspects of the psyche that are not found in other mental illnesses.

These are emotional disturbances in the form of an increasing weakening of feelings in patients, disorders in the sphere of thinking, in particular in the course of associative processes and in the sphere of activity.

But not only clinical experience, but also the history of the development of the doctrine of dementia paraecox - schizophrenia also confirms this. E. Kraepelin (1896), speaking about the amorphous thinking in patients with early dementia, E. Stransky (1909) - about intrapsychic ataxia, Claude and Chaslin - about the discordance of the psyche, E. Bleuler - about schisis, splitting of the psyche, P. A. Ostankov (1913) - about ataxic closures and V.P. Osipov (1931) - about ataxic speech confusion, as if successively deepened the description of the dissociation of mental functions, the same symptoms in this disease. Consequently, both clinical experience and the history of the development of the doctrine of schizophrenia indicate the presence of special symptoms characteristic of schizophrenia. Such symptoms are represented by emotional dullness, ataxic thinking and abulia with parabulia.

Observations show that the earliest symptom of schizophrenia is sensory dullness. In the initial stages of the disease, it manifests itself as a still mild, but already noticeable weakening of emotions in relation to parents, other close and dear people and a weakening of the previously characteristic interests and selective hobbies (“hobbies”). Noteworthy is the gradual weakening of feelings specifically in relation to the most important and emotionally significant persons and circumstances for patients, the weakening of the emotional tone at the points of its greatest “intensity”. First of all, this is reflected in the feeling of love for parents, since the disease most often begins at a young, adolescent age. Emotional movement, feelings for parents weaken, and this is usually complemented by a general change in attitude towards them. Such emotional “dulling” in patients at the beginning of the disease is already evident when there are no productive symptoms or associative and volitional disorders.

At the onset of schizophrenia, weakening of feelings is quite often combined with sensory inadequacy, which is manifested by a more or less pronounced discrepancy between the quality of the emotion and the nature of the stimulus that caused it. First of all and to the greatest extent this manifests itself in feelings for parents. Usually the patient responds to the warm sympathy, tenderness and care of his parents with irritation, hostility and even a feeling of anger. It is noticeable at the same time that the richer and warmer the attitude of the parents, the more obvious the patient’s hostility towards them, often culminating in anger and aggression towards the father and mother. The patient's facial expression and posture then become angry and hostile. Patients often smile inappropriately and even laugh at sad messages and events that are sad for them. It is in connection with such emotional inadequacy and incomprehensible hostility and anger towards parents that patients first come to the attention of psychiatrists, when there are still no “calls” or delusional ideas. This combination of emotional deficit and inadequacy and their complex interweaving manifests sensory dullness in the initial stages of the schizophrenic process.

As the disease progresses, the weakening of the patient's feelings and a general decline in his interests become more and more noticeable. He is already losing love for his parents and loved ones, affection for friends and all other interests and attachments that were previously important to him. At the stage of an expanded schizophrenic process, with inadequacy still persisting for a long time, emotional deficit comes to the fore in the structure of sensory dullness, the patient’s facial expression becomes empty and indifferent. His lack of feelings for family and friends is also revealed in his voice, devoid of intonation and sensual modulations, even when in words he does not deny his commitment to them. Now the simultaneous, as if parallel, weakening of both higher human and lower instinctive feelings, characteristic of schizophrenia, is already being revealed.

Patients are indifferent not only to their favorite (in the past) activities, to social events and the fate of their homeland, but do not show due interest in satisfying their lower, biological feelings (hunger, self-preservation, etc.). This is what explains the passivity of patients in relation to food, their special “tolerance” in relation to painful and thermal effects, and a sharp weakening of the self-defense instinct. A patient with schizophrenia, despite relatively intact memory and intelligence, may remain hungry at lunchtime, since he will not show any “food” activity, while a patient with organic dementia (with reduced intelligence and memory) under the same conditions will show proper activity and get full . This is due to the lack of a sufficient (in this case, food) feeling in a patient with schizophrenia that would cover the entire body and, creating personal interest, would stimulate him to activity. Other lower feelings, in particular sexual feelings, are also weakened in schizophrenia, which has received a special definition in the clinic as “sexual impasse.”

Such a universal defeat of all types of feelings, both higher and lower, emotional disorders in schizophrenia - sensory dullness - are qualitatively different from emotional disorders in gross organic processes (sensory impoverishment), in which there is a weakening (up to complete leveling) of only higher feelings, in while the lower feelings associated with instinctive needs in patients are completely preserved and even strengthened, sometimes naked.

At the final stages of the schizophrenic process (within severe defective and initial states), sensory dullness reaches an extreme degree of severity, mainly due to emotional deficit. Patients are indifferent to family, friends and their own fate, they lose desires, they are not burdened by a constant stay in a psychiatric hospital, they become passive and sloppy. However, in some patients at this stage of the disease, sensory dullness changes, as if “colored” by the patients’ statements on food and sexual topics. But in reality, the point here is not about reviving these lower feelings (which may arise), since the patients do not take any attempts to implement these statements, any actions in this regard and remain as passive as before. In essence, these patients have no lower feelings, and we are talking only about the revival of instincts, since the latter are not accompanied by the necessary subjective reaction of the patient, which would determine his personal involvement and incentive to action. Obviously, such dissociation in the manifestations of feelings in patients indicates a particularly deep damage to the physiological mechanisms of emotions in the final stages of the schizophrenic process. Thus, sensory dullness is a structurally complex symptom, inherent only in schizophrenia, which naturally changes in the dynamics of the disease at various stages of the schizophrenic process in accordance with the progressive dynamics of the latter and reflects the essence of the brain process itself within the framework of the stereotype of the development of the disease.

The next important symptom of schizophrenia, which also constitutes the specificity of its psychopathology, is ataxic thinking. From the moment of onset and during the course of the disease, natural changes in the thinking and speech of patients with schizophrenia are detected. Speech becomes insufficiently specific, too florid, they tend to use abstract expressions more often than before and inappropriately, and “enter into lengthy empty reasoning on abstract, for example, philosophical topics. The central phenomenon of thinking disorders in schizophrenia is ataxic closure, which consists in the fact that in the speech and statements of patients, the natural coordination of elements of thought is disrupted, a unification of ideas that are not coordinated with each other, a combination of incongruous things is observed. In the patient’s phrase, in the verbal expression of his judgments, there is a combination of the incongruous, a combination of normally incompatible sensory-figurative ideas and concepts. The latter are combined in a way that normally never happens. At the same time, a feature of the thinking of patients is that this kind of meaningless combinations (both in oral and written production of patients) are clothed in a grammatically correct form. Here is an example of such a speech: “Apparently, with death you have to wake up with thunder.” This phrase contains a combination of the incongruous; it contains obvious nonsense, since death and the possibility of waking up are mutually exclusive. But the phrase itself is constructed grammatically correctly, since both the main and minor members of the sentence and even the introductory word “apparently” are felt in it.

Clinical practice shows that the severity of this disorder can be very different: in some patients there are only isolated closures in speech, and at the beginning of the conversation they may not be there at all, but they appear at the end as a result of the patient’s fatigue. In other cases, they are extremely frequent, abundant, and then the course of the associative process in these patients turns out to be so deformed that it is classified as ataxic (schizophrenic - according to V.P. Osipov) speech incoherence. And yet, a psychiatrist should think about schizophrenia even when there is no speech confusion in the proper sense of the word, but only isolated ataxic closures, since such a disorder of thinking is inherent only in schizophrenia, is a specifically schizophrenic symptom and does not occur in other psychoses. observed.

One of the specific manifestations of ataxic thinking are neologisms, i.e., words that are formed by patients with schizophrenia as a result of merging, combining into a single concept incompatible syllables. In essence, the same pattern appears in the pathology of thinking, the same ataxic closure, but observed not between words in the same phrase (which is more common), but between syllables, i.e., penetrating into the word itself, into the concept of the patient. Here we are talking about a greater malignancy of the process, as soon as mental ataxia penetrates inside the phoneme and manifests itself, as it were, at a “shorter radius”. “In other cases,” as V. Griesinger writes, “of course, the most interesting ones, new words invented by them appear in the speech of patients, some words are given a completely different meaning, so that the patient makes up a new language for himself... Changes in the form of speech can, on occasion, will serve any experienced physician as diagnostic data.”

With reasoning, on the contrary, coordination is lost not within a phrase or sentence, but between sentences or even entire blocks of sentences. Reasonable statements by patients with schizophrenia are characterized not only by a loss of specificity and extreme generalization of speech, but also by the fact that the patient ultimately loses the original topic. This occurs as a result of the invasion of certain atactic combinations, pathological patterns at the junction of phrases, i.e., the manifestation of the same mental ataxia in the sphere of thinking over a wider radius. It should be borne in mind that reasoning (atactic) occurs only in schizophrenia and the opinion of some authors, who also distinguish asthenic, organic and other types of reasoning, have nothing to do with atactic thinking.

Abulia is the third member of the schizophrenic triad of symptoms. It is known that patients with schizophrenia experience an increasing weakening and disintegration of volitional actions and a transition in their relationships with others to a limited range of automated actions. Patients become more and more passive, they do not take part in work processes in the hospital, are not able to take care of themselves at home (upon discharge), they stop taking care of themselves, become sloppy, spend most of their time in bed or walk around the ward and corridor, not communicating with others and avoiding contact with the doctor. Over time, this abulia grows more and more and leads not only to the disintegration of volitional acts, but also to an increasing limitation of automated and instinctive actions, since patients become passive in relation to the interests of food, self-preservation, etc. Regarding the latter acts, we are not talking about complete disintegration these skills (unconditioned and natural conditioned reflexes), but only about the growing weakness of the impulses for their implementation within the framework of general sensory dullness.

But this does not exhaust the violations of the sphere of activity in schizophrenia. These patients, in addition to the increasing weakening of all forms of activity, are also characterized by various forms of perverted actions - parabulia. This includes a variety of paramimics and parapraxies. Clinical observations show that patients with schizophrenia (regardless of its clinical form) are characterized by a special grimace and a special mannered facial expression. These are various antics, unusual squinting of the eyes, a distorted facial expression, which each patient has their own, individual, is always reproduced in him, but at the same time, they have something in common (at their core) for all patients.

Parapraxia also includes a variety of unusual postures (not related to catatonic disorders), when the patient sits or stands; this is an extraordinary, completely special gait with swaying at the knee and hip joints and pushing the abdomen forward, etc. Parapraxia also includes unusual gestures of patients, especially mannered movements when they offer their hand in greeting, turning it with the volar surface outward, etc. n. Schizophrenia, therefore, is characterized not just by abulia, but by abulia in combination with parabulia.

This is the main sympathomatics of the disease or schizophrenic symptoms proper, with which the diagnosis of schizophrenia begins and in the absence of which such a diagnosis turns out to be unfounded.

Among other manifestations of the disease, one should keep in mind such symptoms as autism, delirium, phenomena of mental automatism and catatonic disorders. At one time, E. Bleuler considered autism one of the main symptoms of schizophrenia. By this disorder he meant the withdrawal of patients from the impressions of the outside world, curtailing relationships with others and immersing them in the world of their own experiences, focusing on elements of their inner world. Understanding the pathogenesis of the disease from a Freudian psychoanalytic position, E. Bleuler assumed the richness and dynamism of the patients’ own inner world, on which they based their so-called introversion.

However, here it is appropriate to recall E. Minkowski’s (1927) description of two types of autism, which he compared to two outwardly identical houses with boarded up shutters, but in one there is life in full swing and “feasts are being celebrated”, and in the other there is darkness, ruins and desolation. He called the first, characteristic of reactive states, productive autism, and the second, characteristic of schizophrenia, unproductive. It is important to keep in mind that in schizophrenia it is precisely non-productive autism that is observed. Such patients are indifferent to their surroundings, they do not care about it, their communication with people is reduced to a minimum, and they are not available for productive mental contact. However, this is not explained by the “load” of patients with their internal experiences (especially since these are sharply impoverished and reduced), but by the increasing sensory dullness, lack of will and passivity of the patients.

Some authors, to substantiate the diagnosis of schizophrenia, refer to extensive delusions and the presence of mental automatism in patients. Indeed, such disorders are often found in this disease and give rise to the identification of its paranoid form; they are characteristic of it, but are not specific to schizophrenia, since they are found in most psychoses. Equally characteristic of schizophrenia and often found in it are catatonic disorders, which led to the identification of its corresponding form. However, they are not specific to schizophrenia. This syndrome has been described in detail in reactive [Morozov G.V., 1968], infectious [Chistovich A.S., 1953], involutional [Smetannikov P.G., 1971] and other psychoses.

In addition to the two mentioned forms of schizophrenia (paranoid and catatonic), it is clinically justified to distinguish simple and hebephrenic forms. Some authors cast doubt on the existence of a simple form, assessing it either as a rapidly developing paranoid defect or as a clinical variant of the hebephrenic form. In reality, there are patients who do not have any significant productive symptoms, but from the very beginning of the disease and in its further course, proper schizophrenic disorders are evident. True, such cases are rare, but they are an undeniable clinical reality. The need to isolate the hebephrenic form is even more obvious, since in many patients with schizophrenia, all productive symptoms are exhausted by the hebephrenic syndrome.

By highlighting these 4 forms of schizophrenia, we mean that the clinical picture of mental disorders is represented each time primarily by the main manifestations of the disease, i.e., schizophrenic symptoms proper (albeit sometimes to an insignificant extent and in incomplete volume) and the corresponding syndrome - paranoid , catatonic or hebephrenic, i.e. formative symptoms. It is in the complex interweaving of actual schizophrenic and formative symptoms that each time one or another picture of the clinical form of schizophrenia appears. It must be borne in mind that both actual schizophrenic and formative symptoms have the same basis - a single pathological brain process. However, their role in the disease and diagnostic significance are completely different, since the first expresses the essence of the process and is the fundamental basis of diagnosis, while the second reflects only particular features of psychopathological disorders and has no diagnostic significance. Clinical experience, the study of the manifestations and dynamics of schizophrenia make it possible to subdivide it into clinical forms and distinguish two types of its course - continuously progressive and paroxysmal-progressive. However, within both of these types and for any of the 4 clinical forms of the disease, a diagnosis of schizophrenia is possible only if proper schizophrenic symptoms are established in its clinical structure.

If you find an error, please select a piece of text and press Ctrl+Enter.