Schizophrenia is a chronic mental illness with distinct symptoms of psychosis, impaired thinking, emotional distress, and inappropriate behavior. Consciousness during illness is not impaired, as well as many intellectual processes are not changed, although with a long course of schizophrenia, the process of perception, attention and memory are disturbed . In schizophrenia, the integrity of the personality is lost, its splitting occurs , the differentiation of one’s “I” is lost , the experience often arises that the most intimate thoughts, feelings and actions are known to the people around them, and they can influence these processes. As the disease progresses, periods of exacerbation and, conversely, periods of remission are possible . With the wrong treatment of schizophrenia, the personality’s ties with its social environment are destroyed , apathy and a decrease in energy potential increase .
Schizophrenia can manifest itself as hallucinations and delusions , often of a bizarre nature. Delirium arises in a patient as a consequence of the need to substantiate what happens to him during the development of the disease, what happens to his perception of the surrounding reality with his thinking. The patient tries to justify the change in his thoughts, their openness to others, and the management of his thinking process. He can consider the effect of unusual and mystical forces, persecution by various organs, the effect on his brain with special invisible rays to be the reason for the change in his state . Schizophrenia is manifested by such symptoms as echo of thoughts (sound of thoughts), insertion or withdrawal of thoughts, openness and transmission of thoughts, delusional perception, delusions of influence. In schizophrenia, hallucinations, imaginary perceptions without an object can occur, more often these are pseudo-hallucinations, auditory hallucinations, of a commentary nature, discussing the patient in the third person. Of particular importance in schizophrenia is negative symptomatology, manifested by a decrease in the energy potential of the individual, negativism, isolation, apathy. According to recent studies, schizophrenia has neurocognitive deficits and autonomic dysfunction .
Forms of schizophrenia
There are various forms of schizophrenia and different types of its course:
- Paranoid schizophrenia (F.20.0) is characterized by persistent delusional ideas, quite often combined with auditory hallucinations. Disturbances from the volitional or emotional sphere are less pronounced than in other forms of schizophrenia.
- Hebephrenic schizophrenia (F.20.1) usually begins in adolescence. In this form of schizophrenia, affective disorders dominate (emotions are superficial and inadequate), delusional and hallucinatory experiences are fragmentary, behavior is unpredictable, mannered and pretentious, negative symptoms, volitional defect and emotional flattening are relatively quickly revealed .
- In the catatonic form of schizophrenia (F.20.2), severe psychomotor disturbances occur, which range from stupor to intense agitation. In this form of schizophrenia, automatic submission and negativism are quite common . Fancy poses can persist for a long time. Catatonia can be combined with a dreamy clouding of consciousness, vivid visual hallucinations.
- Residual (residual) schizophrenia (F.20.5) is essentially a chronic stage of its course and is mainly manifested by negative symptoms: psychomotor retardation, decreased activity, dulling of emotions, passivity and lack of initiative, impaired volitional sphere, poor speech.
- Simple schizophrenia (F.20.6) , another form of schizophrenia, with an imperceptible but progressive development of strange behavior, inability to meet the demands of society, and decreased activity. The characteristic residual symptoms of schizophrenia in this case are formed without episodes of acute psychosis.
From schizophrenia to be distinguished schizophreniform psychosis (F.20.8) – a group of mental disorders with relatively favorable type of flow. In the clinic, only individual symptoms of schizophrenia are observed, and they rather look like additional signs of the disease, and not its main manifestations. With this psychosis, delusions and hallucinations usually predominate .
In terms of differentiation from schizophrenia, schizotypal disorder (F.21) is of interest, manifested by eccentric behavior, impaired thinking and emotions, reminiscent of the manifestations of schizophrenia. Schizotypal disorder resembles personality disorder because it is difficult to determine the onset of its formation.
In the differential diagnosis of schizophrenia, it is important to distinguish it from schizoaffective disorder (F.25), which includes both affective and schizophrenic symptoms. There are manic, depressive, and mixed types of schizoaffective disorder.