Severity of affective disorders do not show a distinct correlation not only with the weight of the negative or positive symptoms of schizophrenia, but , and even with the severity of cognitive impairment.
Some psychiatrists consider affective disorders, especially the depressive spectrum, in schizophrenia to be an independent manifestation of the disease in its genesis. We believe that a separate description of affective disorders in the clinical picture of the disease is reasonable .
At various times, among the manifestations of affective disorders that occur in schizophrenia, mood swings, athymia (“emotional dullness”), and parathymia (“distortion of emotions”), ambivalence of feelings (simultaneous experience of opposite emotions) were described .
It was noted that mood swings can be unexpected and rapid, expressed in varying degrees: from sadness to happiness, from uncertainty to stubbornness, from complacency to tension.
Sometimes the patient’s emotions remain in one key for a long time (“affective immobility”).
The ambivalence of feeling manifested in the fact that they occur at the same time, “crying and laughing at one and the same time”, “feel the fear and along with the bliss”, “considers himself a saint and lewd”, “love and at the same time hates.”
The initial stage of schizophrenia is characterized by a superficial mood with moodiness and inadequacy, and, as a rule, emotional reactions do not correspond to the events taking place. Depression can occur in the prodromal phase of schizophrenia.
It is well known that it is difficult for a doctor to establish emotional contact with a schizophrenic patient, to achieve empathy (praecox feeling). It is assumed that this symptom may be a consequence of the manifestation of negative symptoms or the result of complications of psychotropic therapy. However, taking into account recent studies, it is controversial to assume that affective disorders in schizophrenia are one of its axial syndromes (Cooper S., 2000), a manifestation of negative symptoms (Lindenmayer J., 1992).
In schizophrenia, emotions become less varied, less profound and vivid. Emotional life becomes scarce in this regard, the circle of interests of the patient narrows, his activities become less diverse, and communication with others is less intense or almost stops.
It is difficult for a schizophrenic patient to express his feelings, to accurately react emotionally to a change in the situation. He may look somewhat inhibited, indifferent (“dull and insensitive even to the death of a loved one”).
Expressions of inadequate strength, and sometimes misinterpreted by quality on those or other incentives external world (Semenov S. F., 1962). The emotional state is often characterized by an increased level of anxiety.
Depression in schizophrenia.
The most common affective disorder in schizophrenia is depression or decreased emotional response. At the same time, sometimes there are bright, inappropriate situations of emotion, extreme manifestations of rage, fear, anxiety, fun.
With an acute episode of schizophrenia in 30-40% of patients, depression may be insufficiently noticeable in the clinical picture of the disease. One of the diagnostic markers in this case is the so-called “blasphemy voices”, accusing and reproaching the patient. With the relief of the acute phase of psychosis, depression also loses its severity (Lyubov E.B., 2006). The delusions of guilt in schizophrenia can have a grandiose and fantastic character.
Symptoms of depression are often accompanied by suspiciousness, self- doubt, and fear of physical contact.
Patients can refuse food and take it in the absence of strangers. The relationship between depression and the features of neuroleptic therapy of the disease has been noted (Siris S. et al., 1988).
Note that the diagnosis of schizoaffective disorder should be posed when when the symptoms of depression and symptoms of schizophrenia occur in one and the same time and have a comparable expression of its intensity.
In the process of differential diagnosis of depression in schizophrenia, the latter should also be distinguished from disorders of the affective spectrum caused by organic brain damage, chronic alcohol intoxication, and the use of psychoactive substances.