Schizophrenia - Causes, Symptoms and Treatment .MF .
Schizophrenia ... For many, if not all of the inhabitants, this disease sounds like a brand."Schizophrenic" - a synonym for the final, washed-existence and uselessness to society.Is it so?Alas, in this regard it will be.All the unknown scares and perceived hostility.A patient suffering from schizophrenia, by definition, an enemy of society (I want to see, unfortunately it is in our society, not in the civilized world), because the surrounding afraid and do not understand that the "Martian" is next.Or, worse still, mock and scoff at the accident.Meanwhile, it is not necessary to take such a patient is unconscious deck, he feels very badly, believe, first and foremost attitude.I hope you are interested in and show understanding and, therefore, and sympathy.In addition, I want to note that among these patients, many artists (and many well-known) personalities scientists (the presence of the disease did not detract from their merits), and sometimes simply close people you know.
Let's try to understand the
With Greek.Schizis - splitting, phrenus - aperture (It is believed that there was a soul).
Schizophrenia - is the "queen of psychiatry."To date, 45 million suffer from it. Man, regardless of race, nation and culture she is ill 1% of the population.To date, no clear definition and description of the causes of schizophrenia.The term "schizophrenia" was coined in 1911 by Erwin Blёilerom.Before the move was in the term - "premature dementia".
In domestic psychiatry schizophrenia - is "endogenous chronic disease characterized by various negative and positive symptoms, and is characterized by specific accruing personality changes."
There probably should pause and take a closer determination disassemble elements.From the definition it can be concluded that the disease takes a long time, and carries a certain regularity in the staging and changing symptoms and syndromes.This negative symptoms - a "loss" of the spectrum of mental activity of pre-existing character of this personality - the flattening of emotional responses, reduction of energy potential (but more on that later). Positive same symptoms - is the appearance of new symptoms - delusions, hallucinations.
By nepreryvnotekuschim forms zabolevaniyaotnosyat cases with a gradual progressive development of the disease process, with varying severity of both positive and negative symptoms.With the continuous course of the disease the symptoms observed throughout life from the moment of disease.Moreover, the main manifestations of psychosis based on two main components: delusions and hallucinations.
These forms of endogenous diseases are accompanied by changes in personality.A person becomes a strange, closed, makes absurd, illogical from the point of view of surrounding things.Changes the range of his interests, new, unusual hobbies before.Sometimes it's philosophical or religious teachings of questionable persuasion, or fanatical adherence to the canons of traditional religions.Patients with reduced capacity for work, social adaptation.In severe cases it is possible and the appearance of indifference and passivity, the complete loss of interest.
to flow paroxysmal (recurrent or intermittent form of the disease) is characterized by the emergence of distinct attacks, combined with a mood disorder that brings this form of the disease with a manic-depressive psychosis, the more that mood disorders occupy a significant place in the film attacks.In the case of paroxysmal manifestations of psychotic disorders currents observed in the form of separate episodes, between which are marked "light" intervals relatively good mental state (with high levels of social and labor adaptation), which, when sufficiently long, can be accompanied by a full restoration of ability to work (remission).
intermediate place between these flow types take cases of attack-like progressive form of the disease, when in the presence of a continuous course of the disease is marked appearance of seizures, the clinical picture is determined syndromes similar to recurrent bouts of schizophrenia.
As mentioned earlier, the term "schizophrenia" was introduced Erwin Blёyler.He believed that the key to describe schizophrenia is not the outcome, but "the underlying disorder."He also highlighted the complex characteristic of schizophrenia symptoms, the four "A" tetrad Blёylera:
1. Assotiativny defect - absence related targeted logical thinking (now called "ALOGIA").
2. Symptom autism ( "autos" - grech.- own - distancing from the external reality, dive into their inner world
3. Ambivalence -. The presence in the psyche of the patient affects countervailing love / hate at the same time.
4. Affective inadequate - in a standard situation gives inadequate affect - laughs at the message of the death of relatives
symptoms of schizophrenia
French psychiatric school suggested the scale of deficit and productive symptoms, arranging them according to the degree of increase in German psychiatrist Kurt Schneider described the symptoms I rank..and II rank in schizophrenia "business card" of schizophrenia - I rank symptoms, and now they are still "in vogue":.
1. sounding thoughts - thoughts become sonority, in fact it pseudohallucinations
2. "Voices".who argue among themselves.
3. Commenting hallucinations.
4. Somatic passivity (the patient feels that his motor acts run).
5. "Taking out" and "implementation" of thoughts, shperrung - ( "blockage" of thought), an open mind.
6. Broadcast thoughts (mental broadcasting - as if the head is turned on radio).
7. Feeling "-designed" thoughts, their foreignness - "not your thoughts, put them in the head."The same - with the senses - patsiet describes that it is not he feels hungry, and he is forced to feel hungry.
8. Brad perception - man interprets events in a symbolic way.
In schizophrenia break the boundaries between "self" and "not me".Internal events outside a person believes, and vice versa."Loosened" boundaries.Because of the above features 8 6 talking about this.
views on schizophrenia, as a phenomenon are different:
1. Schizophrenia - a disease - by Kraepelin.
2. Schizophrenia - a reaction - for Bangёferu - the reasons are different, and the brain responds limited set of reactions.
3. Schizophrenia - a violation of this particular adaptation (Amer Laing, Shazh.).
4. Schizophrenia - is a special personality structure (based on the psychoanalytic approach).
Etiopathogenesis (origin, "sources") of schizophrenia
there are 4 "block" theory:
1. Genetic factors.Stable 1% of the population is sick, and if one of the parents is ill, the risk that the sick and the child - 11.8% .If both parents - 25-40% of identical twins and vyshe.U displays the frequency in both at the same time - 85%.
2. Biochemical theory: disorders of dopamine metabolism, serotonin, acetylcholine, glutamate.
3. Stress Theory.
4. Psychosocial hypothesis.
review some theories:
- Stress (very different) affects the "flawed" identity - most often it is the stress associated with a load of adult roles.
- The role of parents: American psychiatrists Bleytseg and Lindsay described "schizophrenogenic mother."As a rule, it is a woman: 1. Cold;2. uncritical;3. Rigid (a "curable", a delayed affect; 4. confused thinking - often "pushes" the child to severe schizophrenia
- There viral theory
- The theory that schizophrenia - a slowly progressive process oslaboumlivayuschy..such as encephalitis volume of the brain in patients suffering from schizophrenia -. reduced
-. in schizophrenia is disturbed filtering information, the selectivity of mental processes, pathopsychological direction
Men and women suffer from schizophrenia, equally often, but citizens -. often poor - most (greater stress.) If patsiet - man, the disease has an earlier onset and severe course, and vice versa
American health care system spends up to 5% of the budget for the treatment of schizophrenia schizophrenia -.. disabling disease, it reduces the patient's life by 10 years leading cause of death.patients are at the I-site - cardiovascular disease, at II-m suicide.
Patients with schizophrenia have a large "reserve prchnosti" to biological stress and physical exertion - can withstand up to 80 doses of insulin, resistant to hypothermia, rarely suffer from SARS and other viral diseases.Reliably calculated that "future patients" are born, usually, at the junction of the winter-spring (March-April) - either because of the vulnerability of jet lag or due to infections effects on the mother.
classification of schizophrenia options.
Adrift distinguish type:
1. Continually-progressive schizophrenia.
a) of attack-like progressive (shift-like)
b) periodic (recurrent).
1. An initial stage (from the first signs of the disease (asthenia) to manifest signs of psychosis (hallucinations, delusions, etc) can also be hypomania, subdepression, depersonalization, etc.
2. Demonstration. disease: a combination of deficit and productive symptoms
3. The final step Marked prevalence of symptoms of deficiency of productive and hardening clinical
In terms of progression of (rate of development):
1. Bystroprogredientnye (malignant);
2. Sredneprogredientnye (paranoid..form);
3. Maloprogredientnaya (sluggish)
exception - recurrent schizophrenia
description of some types:
Malignant schizophrenia : appears between the ages of 2 to 16 years is characterized by a very short an initial stage - to a year manifest....period - up to 4 years old Features:.
a) premorbide (ie.in a state prior to illness) schizoid personality (closed, unsociable, that fear of the external world of the individual);
b) Productive symptoms immediately goes to a high level;
c) At the 3rd year disease-formed apatiko abulicheskimi syndrome (vegetabels - "vegetable life" - with this condition can be reversed at the time of high stress - for example, in case of fire);
g) Treatment is symptomatic.
Sredneprogredientny schizophrenia type : An initial period lasts up to 5 years.There are strange hobby, hobbies, religion.Ill aged 20 to 45 years old.In the manifest period - any form of hallucinatory or delusional.Lasts this period to 20 years.At the final stage of the disease - fragmentation nonsense, it is stored.Treatment effectively possible to achieve drug remission (temporary improvements in health).When continuously progressive schizophrenia hallucinatory-delusional symptoms substantially predominates over the affective (emotional disorders and volitional);with paroxysmal - dominated affective simptomatika.Takzhe - with paroxysmal form of remission deeper and can be spontaneous (spontaneous).When the patient is continuously progredient stationing 2-3 times a year, with paroxysmal - 1 every 3 years.
sluggish, neurosis schizophrenia : Age appearance from 16 to 25 years on average.There is no clear boundary between the manifest and an initial periods.Dominated neurosis phenomena.There psihopatizatsii schizophrenic, but the patient can work, family support and communication links.At the same time it is clear that people "warped" disease.
What are the negative and positive symptoms can be detected?
Let's start with the negative:
1. Engin Bleuler singled associative defect ;
Stransky - interpsychic ataxia ;
well - skhizis .
All this - the loss of the connection, the integrity of mental processes -
a) in thinking;
b) in the emotional sphere;
c) volitional acts.
Author differentiated processes themselves, and in the process itself "a mess."Shizis - unfiltered product of thinking.He is in healthy people, but is controlled by consciousness.Patients it is observed in the initial stage, but usually disappear with the advent of delusions and hallucinations.
2. Autism .The schizophrenic is experiencing anxiety and fear when dealing with the outside world and want to distance themselves from any contact.Autism - a flight from contacts.
3. moralizing - the patient says, but does not move to the goal.
4. Apathy - increasing loss of emotional response - all fewer situations cause emotional reactions.First, there is the rationalization instead of immediate emotions.The first thing that disappears - it's interests and hobbies.( "Sergei, aunt comes" - "come-meet").Teens behave like little old men - seem to be reasonably responsible, but because of this "judgment" a clear depletion of emotional reactions;( "Acne, brush your teeth" - "Why?") That is,He does not give up and do not agree, and trying to rationalize.If the result argument is, why it is necessary to brush your teeth, there is a counter-argument, persuasion may be delayed indefinitely becausethe patient is not going to discuss anything really - he just moralizing.
5. Abul (by Kraepelin) - will disappear.In the early stages of looks like a growing laziness.First - at home, at work, and then in self-service.Patients greater lie.More often there is not apathy, and impoverishment;not abulia and hypobulia.Emotions in patients with schizophrenia, are stored in a single isolated "reserve area", which is called psychiatry parabuliey.Parabuliya can be very diverse - one of the patients gave up working for months and went through the cemetery, making his plan "Trud" has occupied a large volume..Another - counted all the letters "H" in "War and Peace".The third - dropped out of school, walked down the street, collecting animal excrement and the house carefully attach them to the stand, as is done by entomologists with butterflies.Thus, the patient recalls "mechanism running idle".
positive or productive symptoms:
1. Hearing pseudohallucinations (the patient hears the "voice", but does not recognize them as really existing in nature, and are available only to him, "induced" someone or "lowered again").Usually, it is described that these "voices" are not heard as normal, the ear, and the "head", "brain".
2. syndrome of mental automatism (Kandinsky-Clerambault) comprising:
a) delusions of persecution (patients in this condition dangerous t.k.mogut arm for the purpose of defense against imaginary persecutors, and cause injury to anyone whoso considered, or attempt to commit suicide in order to "get it over with");
b) the impact of delirium;
c) hearing pseudohallucinations (described above);
d) Psychic automatism-associative (feeling "-designed" thoughts); senestopatichesky (feeling "-designed" feelings); a motor (a feeling that certain movements that he does not it, and imposed on him from outside, it forced them to do).
3. Catatonia, hebephrenia - hardening in one position often uncomfortable for long hours, or vice versa-sharp disinhibition, silliness, grimacing.
According neurodevelopmental theories of positive symptoms of the disease is caused by a dysfunction of the system of the caudate nucleus of the brain, the limbic system.Detected a mismatch in the hemispheres, dysfunction of fronto-cerebellar connections.On CT (computed tomography of the brain) can detect the expansion of the anterior and posterior horns of the ventricular system.When the nuclear forms of the disease on the EEG (electroencephalogram), reduced voltage to the frontal leads.
Diagnosis is based on identification of the main productive symptoms, which are combined with the negative emotional and volitional disorders, leading to the loss of interpersonal communication with a total duration of follow-up of 6 months.The most important in the diagnosis of disorders is the identification of the productive symptoms impact on the thoughts, actions and mood, hearing pseudohallucinations, symptoms openness of thought, rough formal thought disorder in the form of incoherence, catatonic movement disorders.Among the negative disturbances pay attention to the reduction of the energy potential, alienation and coldness, unfounded hostility and loss of contacts, social decline.Prognosis is poor.