Schizophrenia is a hereditary-constitutional progressive mental illness characterized by a number of patho-homonic psychopathological symptoms and syndromes. The characteristic manifestations include the so-called "symptoms of the first rank" by Kurt Schneider: commenting and imperative verbal pseudo-hallucinations; the feeling of "confiscation or" embedding "by outsiders of thoughts in the patient's head; the belief that the patient’s thoughts are known to others and transmitted by other people like on the radio; “Embedding” in the patient’s consciousness the sensations of other people, their delusional ideas of influence.
Along with the listed symptoms, the detection of which significantly increases the likelihood of diagnosing schizophrenia, there are a large number of others affecting the pathology of various cognitive processes. First of all, with schizophrenia, the thought process, perception, emotional-volitional sphere suffer, while memory and intelligence disorders are not typical.
In the clinical field, there are many classification systems for both mental disorders in general and for particular groups of disorders. So, P. Berner, E. Gabriel, H. Katschnig et al. (1983) cite 15 different classification systems for schizophrenic disorders (e.g. St. Louis criteria, RDC criteria, ICD-9). Hence the need for a multi-diagnostic approach, in which the most important systems would be taken into account at the same time. Recently, however, many classification systems have lost their importance due to the dominance of two international classification systems for mental disorders: ICD (International Classification of Diseases) and DSM (Diagnostic and Statistical Manual of Mental Disorders)
Features of schizophrenia as a disorder
The allocation of schizophrenia as an independent disease called “early dementia” is usually associated with the name of the German psychiatrist Kraepelin E., who described the clinic, course and outcome of this disease at the end of the last century (1898). However, the clinical manifestations of schizophrenia have been described under different names by Russian and foreign psychiatrists much earlier. So, Bukovsky P.A. Described this disease in 1834 under the name "virtue." The pathophysiological mechanisms of schizophrenia were first substantiated by the Russian physiologist Pavlov I.P.
Schizophrenia is one of the most common mental illnesses. In different countries, the number of patients with this disease in the population ranges from 0.15 to 1-2%. The risk of schizophrenia is 10-25% for a child who has one of the parents sick, and 35-45% if both parents suffer from this psychosis. At the same time, the average risk of the disease for the entire population of the globe is 0.85%. It tends to a chronic course and often leads to a significant change in personality, thinking defects, disorders of the emotional-volitional sphere, and apathetic dementia. The clinical manifestations of schizophrenia are characterized by a polymorphism of symptoms and syndromes - it is characterized by a variety of flow patterns with the presence of various stages and forms of the disease.
Often, at the beginning of the disease, patients have a peculiar tendency to symbolism in thinking, which gives originality and non-standard to the statements, encourages them to poetic creativity. Being engaged in creativity, they strive for schematization, for combining incompatible parts with each other. In addition, there is a pronounced resonance (endless debate on any occasion, they begin to write scientific treatises without the necessary knowledge). Patients often complain of a break in thought, in which they seem to forget what they just talked about, with a feeling of emptiness in their heads. In addition to this, there are influxes of thoughts, as if forcibly invading. Perseveration of individual thoughts and words is observed. Often patients have a syndrome of mental automatism in the form of the phenomenon of openness of their own thoughts. In adults, the formation of overvalued and crazy ideas is also observed.
Of the emotional disorders at the beginning of the disease, a peculiar vulnerability and sensitivity to events that do not directly affect the patient or his relatives (when watching a movie, reading books), but are indifferent to relatives, is often noted. They show inadequacy in emotions, their facial expressions often look paradoxical.
Volitional activity in the early stages of the disease is often quite high, but mainly aimed at realizing any unilateral interests of drives. In other areas, volitional activity is not applied.
With the further development of the disease and its aggravation, disorganization of thinking is observed, i.e. First, a logical connection is broken between separate conclusions, then between separate phrases and, finally, inside a phrase between words, while the laws of linguistic relations are relatively intact. Patients lose the ability to subtle experiences and expression of feelings, while maintaining the ability to express elementary emotions (emotional dullness). Gradually, elements of motor-volitional disorders appear in the form of catatonic symptoms; perseveration and stereotyping in speech and movements, echosymptoms, catatonic stupor phenomena (characterized by silence (mutism), immobilization and increased muscle tone. Abulia develops - patients are completely inactive, inactive and can not be involved in any meaningful activity for even a short time .
The course of the disease is different. Melekhov D.E. distinguishes the following types; malignant, rapidly progressing, in which already in the first or second year of the disease, the personality decays and the patient becomes completely incapacitated; a progressive prolonged course, also an unfavorable form, in which, however, disability occurs after several years of continuous illness; Slow and sluggish current schizophrenia, when for many (10–12) years neurosis-like and hypochondriacal states are observed without deep remissions, but also without a pronounced defect; paroxysmal ongoing progressive schizophrenia; remitting course, when deep remissions occur between seizures, and after the first seizures, disability can be fully restored.
From early historical times, there are descriptions of people whose behavior was considered deviant, abnormal, sick or caused by an obsession with the devil. Biblical descriptions of this behavior can be divided into 3 main types: depression, mania, and the disorder now called schizophrenia.
For the first time this disease was described by Kraepelin E. in 1898 under the name "early dementia." Kraepelin E. believed that it begins at a young age and invariably leads to the same outcome - dementia.
The concept of Kraepelin E. met with many objections. It was soon established that “early dementia” does not always begin at a young age, and later it became clear that dementia is not mandatory.
These circumstances, known even to Korsakov S.S., later served for Bleiler E. as one of the reasons for changing the name of the disease.
The diagnostic mode changes over time; these disorders were designated paranoia, schizophrenic reactions, and early dementia. The official term now is schizophrenic disorder. Today, schizophrenia is considered a complex psychobiological disease that causes disorganization, accompanied by cardinal personality changes and a pronounced worsening of adaptive behavior. The disease has a predictable course and a predictable outcome. At the moment, we do not know the exact etiology of schizophrenia and do not know how to treat it. We know some of the genetic determinants and some biological reactions (windows). Accumulated a lot of information about interpersonal and social. situations provoking exacerbation of symptoms in people with schizophrenia.
Modern diagnostic systems of schizophrenia begin with the work of E. Bleiler at the turn of the 20th century. He grouped these disorders and proposed the term "Schizophrenia", referring to the split between thinking and affect.
A modern schizophrenia diagnostic system developed by C. Schneider, who formulated 11 symptoms of the first rank. These include: the perception of audible thoughts, arguing voices and voices, commenting on the patient’s actions, external influences on the body (influence playing on the body), somatic passivity, thought withdrawal, putting thoughts from the side, leakage and transmission of thoughts, made impulses, made feelings and made willful acts, delusional perception. Although these 11 symptoms of the first rank are indeed observed in many. suffering from schizophrenia, they are manifestations of the final stage of the disease and are observed only in relatively acute episodes.
In the system developed by Mendel, DOS. on long-term follow-up of almost 500 cases, the diagnosis of schizophrenia is made on the basis of the presence of three nuclear disorders: inability to cope with anxiety, impaired interpersonal transactions and lack of historicity. In this diagnostic system, all other signs and symptoms are either the consequences of these nuclear disorders, or attempts at restitution. With an exacerbation of the disease process, initiated and restorative symptoms appear, and in calmer periods of remission, when maintenance therapy is available, only nuclear disorders can be observed; other symptoms do not appear. With this diagnostic approach, the goal of effective therapy - with chemical or psychotherapeutic agents - is to eliminate initiated (nuclear disorders) and restorative symptoms.
According to the official diagnostic system of the American Psychiatric Association, known as the “Guidelines for the Diagnosis and Statistical Classification of Mental Disorders” (DSM-IV), schizophrenia can be diagnosed with the disease for at least 6 months, which defines schizophrenia as a chronic process. During periods of sharp exacerbation, in the active phase of the disease, the presence of at least one of the following symptoms is required:
- freakish nonsense;
- delusions of somatic or religious content, delusions of greatness, denial or other delusions without ideas of persecution or jealousy;
- delusions of persecution or jealousy;
- auditory hallucinations;
- incoherence of thinking, noticeable in the weakening of the association, illogicality or poverty of thoughts and associated with one of the following symptoms: flattened or inadequate affect, delirium or hallucinations, catatonic or other grossly disorganized behavior.
DSM also prescribes the presence of a decrease in the level of functioning in such areas of activity as work, social. relationships and self-care. In this guide, schizophrenia is divided into disorganized, catatonic, paranoid, undifferentiated, and residual types. Subtypes are characterized by various complexes of dominant symptoms.
A typical course of the disease begins with an acute episode, usually in adolescence (13-17 years). Often this early episode is misdiagnosed. The initial episode is usually stopped spontaneously, its duration is several weeks, and then there comes a remission, in which the patient's behavior looks close to normal. The second episode usually occurs after six months or a year, its manifestations are more intense and distinct, the duration is several weeks. The third episode is usually diagnosed as the first episode of psychosis. This occurs within 1-2 years after the initial episode and is accompanied by severe violations of daily adaptation.
The subsequent course of the disease is characterized by relapses and remissions. The number of relapses during the year is more related to age than to treatment or the environment of the patient. At the age of 20-30, an average of six relapses is noted. At the age of 30-40 years, the average number is two relapses per year, and at the age of 40-50 years an average of one relapse per year. After 50 years, usually no exacerbations occur. During periods of exacerbation, manifest psychotic symptoms are observed: delirium, hallucinations, disorganization of thinking and impaired functioning. In periods of remission, the patient is often free of psychotic symptoms, especially when taking adequate psychopharmacological agents. However, nuclear symptoms persist and can be detected even in remissions.
There is one type of schizophrenia with a later onset - paranoid schizophrenia. For this type, the average age of manifestation of psychosis is the beginning of the third decade of life. Paranoid patients exhibit less pronounced impaired functioning in between acute episodes.
Schizophrenia affects about 1% of the population. The incidence is the same for all cultures and subcultures, for all races, it is the same for industrially developed and underdeveloped countries. There is no confirmation that differences in social affiliation. class affect the incidence of schizophrenia.
Since the 1980s treatment of schizophrenia consisted of psychopharmacology, psychotherapy and manipulation of the patient’s environment. Good supportive therapy can significantly improve the quality of life of patient S. The patient can spend most of his life not in the hospital, but in society. Manipulation of the environment consists in creating a psychosocial environment in which disability is minimized and the patient feels comfortable.
Characteristics of personality in schizophrenia
Consider the features of attention, perception, thinking, emotions and will in patients with schizophrenia.
Attention. E. Kraepelin, the founder of the doctrine of schizophrenia, was interested in studying the functioning of the attention process and believed that the difference between active and passive attention is characteristic of patients with schizophrenia. Other researchers (E. Magee and J. Lapman) during the noise immunity experiments found that schizophrenia impaired the filtration mechanism and filter tuning mechanisms. Modern theories of attention disorders in schizophrenia are noted by a defect in either automatic or conceptual processing of information (Yu.B. Dormashev, V.Ya. Romanov).
Perception. Typical disturbances in the perception process, along with classical hallucinatory phenomena, include increased brightness, saturation of the visual and auditory analyzers. An aggravation of perception occurs, associated with an overabundance of incoming stimuli. In patients with schizophrenia, the filtering process of the incoming signals is disrupted in the direction of increasing their number, which facilitates the direct penetration into the brain of an unregulated flow of sensory stimuli. The reports of a number of researchers that in some cases with schizophrenia can be suppressed until the pain disappears completely disappear. One of the main pathopsychological signs of the disease is the inability of patients not only to sort and interpret incoming signals, but also to respond accordingly. In the clinic, this is manifested by difficulties that arise in patients in understanding the incoming signals, in particular, at the level of communication.
Memory. According to V.M. Bleicher, an indirect sign of the presence of affective-personality changes in patients with schizophrenia is a 10-word plateau storage curve in the absence of a clinically determined memory loss.
Thinking. Clinical signs that are pathognomonic for schizophrenia are classified as torn thinking, resonance, mentism, and sperrung. In pathopsychological experiments, the most typical manifestations of the distortion of generalization processes are revealed: slippage, diversity, as well as specific thinking and some others. The symptoms are most clearly identified during the classification technique. Patients in the process of completing tasks identify groups, combining concepts based on not basic, but latent, non-essential signs. The same results are obtained when schizophrenic patients perform techniques to discriminate between the properties of concepts.
Some authors reveal the specificity of patients' thinking, manifested by the loss of ability to abstract, others write about the typical manifestation of the diversity of thinking due to impaired purposeful thinking. It should be noted that the identification of such a wide and contradictory spectrum of mental disorders can be explained by various forms of schizophrenia.
Vivid and pronounced clinical and pathopsychological signs can be found when carrying out the pictogram technique. According to B.V. Zeigarnik, in patients with schizophrenia, when researching this technique with a disorder, the correlation of abstract-semantic and subject-specific components of analytical and synthetic activity can be regarded as the result of a violation of the interaction of signal systems.
An interesting opinion is that patients with schizophrenia disrupt the perception of words and the so-called pathological polysemantism, i.e. words begin to acquire multiple meanings and often the semantic structure of the word is shaken. On the basis of this process, amorphous thinking and a symptom of resonance are formed.
V.M. Bleicher believes that the largest number of erroneous solutions to problems of the schizophrenic type (distortion of generalization, slipping, diversity, simultaneous coexistence of different levels of generalizations and the use of various parameters of the criteria according to which judgments are made) in the initial stage of the disease is noted by the classification method, whereas by the exclusion method deviations are not detected. With a pronounced schizophrenic defect, the diagnostic significance of using the techniques is equalized.
O. Maller described in the schizophrenia clinic a motivational syndrome, which includes impaired motivation and motivation, which is central to the development of the pathological process, in particular, characteristic mental disorders. The essence of motivational thinking, according to V.M. Bleicher, associated with the reduction of energy potential, is a procedural progression, leading to the breakdown of thinking. In its pure form, it is presented with a simple form of schizophrenia.
OK. Tikhomirov traced three links in the psychological mechanism of impaired thinking in schizophenia. The first link is a violation of the motivational sphere, which leads to violations of the personal meaning. For patients with schizophrenia, the personal meaning of objects and phenomena often does not coincide with the generally accepted and conditional knowledge of a person about them. At the same time, standard and non-standard informative features are equalized. The second link - giving non-standard informative features more importance than standard ones. Violation of the selectivity of information is the third link.
Emotions. Pathognomonic disturbances of emotions in schizophrenia are in the nature of negative symptoms. Clinically, they are manifested by a decrease in the severity of emotional experiences, apathy, inadequate affect (paratimia). Along with this, ambivalence is considered a clinical manifestation characteristic of schizophrenia - ambivalence in emotional assessment, experiences of the vast majority of events that take place.
Will and motivation. Negative symptoms of volitional disorders can also be attributed to typical schizophrenia. The clinic is clearly manifested by a decrease in energy potential, abulia, a decrease in the control of motor acts, ambitiousness and autization. Special symptoms of a disorder of the motor-volitional sphere include manifestations of a catatonic syndrome (agitation and stupor), impulsive actions, stereotyping, catalepsy.
Consciousness and self-awareness. In some forms of schizophrenia, identity disorders are considered typical. Violations of consciousness in a psychiatric context are manifested in only one form - oneiric disorder of consciousness.
Thus, it is clear that such a disorder as schizophrenia leaves its mark on all mental processes, as well as on the emotional-volitional sphere of the personality.
Description of the main forms
Researchers distinguish the following forms of schizophrenia.
1. Hebephrenic - emotional disorders are put forward in the clinical picture. The disease begins most often in adolescence and youth, but it can also be in children of different ages. The course is paroxysmal and malignant, leading to a pronounced mental defect. The attack is accompanied by high spirits with foolishness, inappropriate and inappropriate grimaces, elaborate gestures. Facial expression is paradoxical, actions are impulsive. In patients' statements, fragmentary delusions sound, elements of diversity and disruption appear. As the disease progresses, abulia sets in quite quickly (patients are completely inactive, inactive), pronounced tearing of thought (logical connection is broken at first between individual conclusions, then phrases, and, finally, between phrases between words) and emotional dullness (loss to subtle feelings and expressions occurs feelings, while maintaining their ability to express elementary emotions).
2. Catatonic - the main manifestations are motor-volitional disorders. It can begin at any age.
Almost always, a paroxysmal course. Patients develop an empty catatonic stupor with mutism (immobilization and increased muscle tone with silence), there is an air-cushion syndrome (when you lie on your back for hours, and sometimes for days, your head remains elevated above the pillow), stereotypical repetitions of the same movements, repetition of words and movements of surrounding people (echosymptoms), solidification for a long time in the same position (catalepsy). In addition, fragmentary delusions, emotional inadequate reactions, and separate hallucinatory episodes can be observed. As the episodes of the disease recur, emotional dullness, non-disappearing abulia, and torn thinking and speech come quite quickly.
Although the catatonic form develops more often between 20 and 30 years, cases of it are also known at a later age, for example, in the menopause. The transition from the stage of neurosis-like manifestations to the catatonic form, as a rule, occurs quickly. At the same time, the features inherent in the initial stage of the disease seem to be sharpened: anxiety grows, sometimes there is fear, auditory hallucinations of unpleasant content, threatening or imperative. Simultaneously with all this, there may be delusions of persecution. Patients become agitated, and motor excitement, which initially has the character of ordered actions, goes into a characteristic catatonic agitation with its stereotype. A feature of catatonic excitement is that it looks very much like hyperginesis, has no focus, and is also accompanied by speech excitement with disruption and often with complete incoherence. For catatonic conditions, the most typical combination of pathological subordination, which usually clearly appears even at the most extreme degrees of arousal. They can resist when trying to wash them, put them on, comb their hair.
3. A simple form - disturbances in thinking, emotions, wills are observed in equal proportions, with negative symptoms prevailing. The course is different.
With this form, emotional-volitional disorders accompanied by a slowly increasing decrease in intelligence are cross-cutting in the picture of the disease. The transition from the initial stage to the stage of flowering of symptoms with this form is almost imperceptible. Relatives usually begin to notice the disease during the period when it reaches significant development. This form is more common at puberty and is characterized by an increase in the impoverishment of the individual, lethargy, apathy, and affective dullness.
4. The paranoid form. Like a simple form of schizophrenia, the paranoid form is characterized by a gradual development. In this case, delusions and signs of mental automatism are revealed. Often patients have thoughts that the people around them have changed their attitude to them. Often patients complain that they are under the influence of some external forces and most often associate this with the influence of ill-wishers and conspirators. It should be emphasized that with this form of schizophrenia, along with delusions of attitude and persecution, hypochondriacal delusions are often noted. In the late period of the disease, delirium loses connectivity, becomes torn and ridiculous.
5. The circular form. This form of schizophrenia is characterized by a periodic course and is manifested by manic or depressive syndrome. Out of seizures, remission is noted. Manic and depressive symptoms occur, which is combined with each other.
Thus, regardless of the form, sooner or later, a mental defect develops in the form of abulia, emotional dullness and torn thinking. Three forms (hebephrenic, catatonic, simple) can be observed in children, while the latter forms begin in adolescence and the first half of adulthood, and is characterized by impaired thinking in the form of delusions. Although in some other sources, the paranoid form is isolated separately in adolescents and even in children.
Modern Classifications of Schizophrenia
As you know, the classification of schizophrenia and schizophrenic disorders, starting with E. Kraepelin and to the present, is carried out according to clinical forms and types of course. Classification of schizophrenia according to clinical forms, that is, according to the prevailing psychopathological syndrome, has long been the leading one in Russia and still remains the main one in foreign psychiatry.
E. Kraepelin and E. Bleuler initially described simple, hebephrenic, catatonic and paranoid forms of schizophrenia. In the future, the classification was gradually complicated by crushing old and isolating new clinical forms, but it was supposed to take into account the type of the course of the disease, especially its occurrence, etc. So, V.M. Banshchikov and T.A. Nevzorov was divided into schizophrenia into forms: simple (options - apato-abulic, psychopathic and neurosis-like), paranoid (options - hallucinatory-paranoid, paranoid, paraphrenic, with Kandinsky-Clerambo syndrome), catatonic (options - akinetic, hyperkinet, hyperkinet catatonic), hebephrenic (options - hebephrenic, hebefreno-catatonic, hebefreno-catatonic-paranoid excitation). Along with the clinical form, they proposed taking into account the rate of detection of psychopathological symptoms (acute or gradual), the rate of development (fast or slow), type of course (periodic, progressive-progressive, and continuously-progressive) and outcome.
Currently, two diagnostic systems are most common in the world:
- The International Classification of Diseases (currently ICD-10), created by the World Health Organization. Used in European countries, including Russia and Ukraine.
- A Handbook for the Diagnosis and Statistics of Mental Disorders (currently DSM-IV-TR) published by the American Psychiatric Association. It is used in the USA, China, Japan and other countries of the world, as well as during most research projects, including clinical trials of pharmacological preparations.
These classifications have both a number of common characteristics and a number of differences.
Both classifications are based on extra-etiological criteria, operational, syndromologically oriented. The diagnosis of schizophrenia is based on the clinical characteristics of the syndrome taken in cross section without regard to its dynamics. The main component of classifications is a diagnostic algorithm that allows, on the basis of rigidly formulated criteria (signs and symptoms), to come to the same diagnostic conclusions. In both classifications, the diagnosis of schizophrenia is considered as an independent mental disorder (psychosis), the basis of differential diagnosis is the principle of exclusion of organic, affective, dependent and other disorders. This approach has led to a significant narrowing of the boundaries of schizophrenia.
With a sufficiently large commonality of approaches and principles, these classifications have significant differences.
The DSM classification is multi-axis and includes 5 axes. The first three axes are designed to formulate officially accepted diagnostic categories, 4 and 5 axes complement the medical diagnosis:
- Axis I - clinical syndromes;
- Axis II - developmental disorders and personality disorders;
- Axis III - somatic disorders and conditions;
- Axis IV - the severity of psychosocial stress;
- Axis V - overall performance assessment.
This diagnosis allows you to consider not only the clinical picture of the disease, but also the socio-psychological characteristics of the patient.
The parameters of the duration of psychosis (at least 6 months) and a decrease in the level of social and professional functioning are introduced as mandatory.
In the DSM, catatonic, paranoid, disorganized, residual, and undifferentiated types of schizophrenia are distinguished.
The types of flow are represented by five options:
- Subacute with acute exacerbation;
- Chronic with acute exacerbation;
- In a state of remission.
The ICD-10 is based on the conceptual approach of the Heidelberg’a German school, whose prominent representatives were G. Grule, V. Mayer-Gross, C. Wilmans and K. Schneider. ICD - 10, in contrast to DSM-IV-TR, is less rigidly formalized and retained the diagnosis of “simple schizophrenia”, as historically established in European psychiatry. The epigraph to ICD-10 may be the thought expressed in the famous 9th volume of the Guide, O. Bumke (1932), by the German psychiatrist Kurt Schneider: “In our opinion, the diagnosis of schizophrenia is based mainly not on the evolution of the clinical picture, but on the actual condition of symptomatology. " In fact, K. Schneider’s statement expressed the idea of the presence of pathognomonic for schizophrenia (mental automatism syndrome), “static” symptom complexes. The evolutionary principle of the diagnosis of schizophrenia, which was the basis of the Kraepelin and partly Bleiler paradigm, was leveled, the concepts of “course of the disease” traditional for Russian psychiatry were not taken into account.
Since 1975, the ICD-9 classification has been used in domestic psychiatry, and since 2000, the ICD-10 has been used in Ukraine. Classical Krepelin forms are present in both classifications. The principal difference between diagnostic systems is the absence of “latent sluggish schizophrenia” in the ICD-10 and the introduction of a new diagnostic taxon “post schizophrenic depression”.
In the modern American psychiatric classification DSM-IV-TM, only paranoid, disorganized (corresponds to hebephrenic schizophrenia), catatonic, undifferentiated and residual types are included in schizophrenia as a group of schizophrenia, and schizoaffective and schizophrenia-like disorders are considered separately from schizophrenic schizophrenia attributed to personality disorders.
Many researchers believe that in addition to these categories of DSM-IV-TM, the course of the disease helps to predict the differences between the so-called type I and type II schizophrenia. Schizophrenia with predominantly positive symptoms of T.J. Crow belonged to type I, and with negative - to type II. Thus, he identified two syndromes in the disease that correspond to a number of signs of schizophrenia: a) type I (positive symptoms, sudden onset, good prognosis, preservation of intellectual functions, good premorbid adaptability, a small number of neurological abnormalities, can be treated with medication); b) type II (negative symptoms, slow inconspicuous onset, poor prognosis, impaired intelligence, poor premorbid adaptability, cell death and neurological changes, poorly respond to medical treatment). Patients with type I schizophrenia are characterized mainly by better adaptability to the disease, later onset of symptoms, a higher likelihood of improvement and they respond better to antipsychotic drugs than patients with type II schizophrenia.
This division has been criticized, since types I and II overlap in many ways, and in this case they speak of “mixed schizophrenia”. In addition, in the theoretical division by T.J. Crow (1980) does not take into account the joint manifestation of positive and negative symptoms in the same individual.
The International Classification of Diseases of the 10th revision, recommended for use in Ukraine, provides for the diagnosis of paranoid, hebephrenic, catatonic, undifferentiated and simple types of schizophrenia, as well as residual schizophrenia, post schizophrenic depression, unspecified schizophrenia and other forms of schizophrenia. Schizotypal disorders (includes latent, pseudo-neurotic schizophrenia and other disorders), acute and transient psychotic disorders (acute polymorphic psychotic disorder without symptoms of schizophrenia, acute polymorphic psychotic disorder with symptoms of schizophrenia, acute schizophrenia-like psychotic disorder, mixed schizophrenia, schizo ) are considered separately from schizophrenia.
For all forms of schizophrenia, an additional coding of course options is used for at least a year of observation: 1) continuous (non-remission) - F20.x0; 2) episodic with increasing negative symptoms - F20.x1; 3) episodic with stable negative symptoms - F20.x2; 4) episodic remitting - F20.x3; 5) the state of incomplete remission - F20.x4; 6) the state of complete remission - F20.x5; 6) the other is F20.x7; 7) a follow-up period of less than a year - F20.x9.
Classification of clinical forms by many authors is considered more preferable because the most common method of treating schizophrenia with psychotropic drugs is based on the account of the leading psychopathological syndrome, that is, the clinical form of schizophrenic disorders. Along with this, psychiatrists who offer to classify schizophrenia according to clinical forms (therefore, according to psychopathological syndromes), note the possibility of a different course of the previously listed forms. In their opinion, the course can be periodic, paroxysmal-progressive (fur-like) and continuous with a steady increase in the schizophrenic defect, but in most cases of the most common clinical forms (simple, hebephrenic, catatonic and paranoid) the last two types of disorders are most common.
The classification of schizophrenia by type (form) of the course was proposed by I.F. Sluchevsky, A.V. Snezhnevsky, O.V. Kerbikov, R.A. Nadzharov, P.G. Smetannikov and a number of other scientists. Currently, given the data of the specialized literature, most domestic psychiatrists adhere to it, although in practice they are forced to use the official classification of ICD according to clinical forms for encrypting diagnoses.
R.A. Nadzharov, A.S. Tiganov, A.B. Smulevich et al. adhering to this principle, the following forms of the course of schizophrenia are described: 1) continuous-flowing - malignant, progressive (paranoid with paranoid, paranoid, paraphrenic and hallucinatory-paranoid variants), lethargic (slightly progressive with obsessions, hysterical, or hypochondria); 2) paroxysmal-progressive or fur-like - a malignant variant, schizoaffective seizures (affective-delusional, affective-hallucinatory or with Kandinsky-Clerambo syndrome), sluggish neurosis-like and psychopathic types; 3) recurrent - with oneiroid-catatonic, depressive-paranoid and affective seizures; 4) special forms of schizophrenia - febrile, latent, residual, pseudo-psychopathies, hypoparanic, hypochondriac, hyperthymic and other types, pseudoneurosis with obsessions, etc., paranoia and late schizophrenia with hallucinatory-paranoid, delusional, and other paraphrenic.
I. Mitteilung, N. Petrilowitsch used the classification of schizophrenia depending on the state of affect: 1) psychosis with polymorphic affect; 2) affective psychoses with monomeric affect and polymorphic affect; 3) hebefren process with amorphous affect; 4) a paranoid form with monomorphic or stable polymorphic affect.
Many researchers consider it appropriate to simultaneously use diagnostics and classification according to the leading psychopathological syndrome and course, as this allows us to more specifically determine the characteristics of each case of the disease and the circumstances of its occurrence, for example, in epidemiological studies. At the same time, they often point out difficulties in determining the clinical form due to age-related characteristics of psychopathological symptoms, drug and other pathomorphism.
Thus, the data presented indicate that in some classifications there is a departure away from the nosological principle and a lack of encouragement to establish causal relationships in mental pathology. However, one can agree with the opinion of authors who believe that it is the nosological principle that should remain one of the leading ones in the further development and improvement of statistical classifications of mental disorders, including the classification of schizophrenia. Also, a psychiatric section of the international classification of diseases of revision 11 (ICD - 11) is being developed.
So, as the analysis of the literature has shown, the picture of schizophrenia is extremely polymorphic, therefore the behavior of the doctor depends on what clinical symptoms prevail. The patient’s behavior, his reaction to current events, to his condition depend on the characteristics of mental activity at various stages of the development of the disease. On the one hand, a change in mental activity is characterized by such productive psychotic symptoms as delirium, hallucinations, catatonic and affective disorders, and on the other, negative, indicating a more or less pronounced defect, insufficiency of mental functions.
Patients with schizophrenia may experience such a disorder in associative activity when they cannot (regardless of their efforts) collect their thoughts for the consistent presentation of complaints. Patients at the same time give the impression of absent-minded, stupid, distracted by their experiences. They may experience a sense of change (unpleasant or terrible) of their own “I” or the world around them, or the relationship between the “I” and the world (depersonalization, derealization).
Impaired thinking is one of the most common symptoms in mental illness. The clinical options for thinking disorders are extremely diverse. Some of them are considered typical for one form or another of the disease. When diagnosing a disease, the psychiatrist is often guided by the presence of one or another type of impaired thinking.
The data presented indicate that in some classifications there is a departure away from the nosological principle and a lack of encouragement to establish causal relationships in mental pathology. However, it is the nosological principle that should remain one of the leading ones in the further development and improvement of the statistical classifications of mental disorders, including the classification of schizophrenia. Also, a psychiatric section of the international classification of diseases of revision 11 (ICD - 11) is being developed.
For the prevention of schizophrenia, the prevention of marriages between patients with this disease is of great importance, since the risk of illness in children in this case increases to 38-68%, while in the presence of one sick parent it is 14%. Studying the characteristics of the mental development of the offspring of parents with schizophrenia, the possibility of disease manifestation is significantly increased with signs of dysontogenesis in a distorted and delayed type, the presence of "disordered" behavior, an increased tendency to psychogenic reactions. Dispensary observation of such children, correction of their improper upbringing, prevention of the onset and severe course of infectious diseases can to some extent prevent the manifestation of the disease. Secondary prevention (i.e. preventing relapse and a clinically unfavorable course) of schizophrenia in children and adolescents consists in the early detection of the disease with the help of preventive mass screenings of children in schools and preschool institutions, as well as in the long-term so-called maintenance treatment of sick children after their treatment.