Lecture
Questions for consideration:
Schizophrenia – a progredient mental illness characterized by typical personality changes and a distinctive defect.
According to epidemiological studies, the prevalence of schizophrenia worldwide is estimated, depending on the criteria and registration principles adopted, to be in the range of 0.5–1.6% (Jablensky A., 1995; Saha et al., 2005). About 55 million people worldwide suffer from schizophrenia, and the number of new cases per year exceeds 5 million.
The modal age of onset of the illness is 18–25 for men and 25–30 for women. There is evidence indicating a significant material burden
of schizophrenia for society (0.2% of gross domestic product). Up to 40% of the budget for psychiatric care in our country
Clinical picture of schizophrenia
«NEGATIVE» (Deficit) disorders
1. structural thought disorders (incoherence, reasoning [resonerstvo], multiplanarity)
2. symptoms of qualitative distortion of emotions
3. volitional disorders (ambivalence, ambitendency, hypobulia, negativism)
4. personality disorders (autism, decreased energy potential)
«POSITIVE» (productive) disorders
1. hallucinatory-delusional disorders
2. catatonic phenomena
3. hebephrenic symptomatology
4. affective-delusional disorders
Schizophrenia: first-rank symptoms according to K. Schneider (according to R. Shader, 1998)
1. Thought broadcasting – the sensation that one's thoughts are audible at a distance
2. Feeling of alienation – the sensation that thoughts, impulses, and actions originate from external sources and do not belong to the patient
3. Feeling of influence – the sensation that thoughts, feelings, and actions are imposed by certain external forces to which one must passively submit
4. Delusional perception – the organization of real perceptions into a special system, often leading to false beliefs and conflict with reality
5. Auditory hallucinations – clearly heard voices coming from inside the head (pseudohallucinations), commenting on the patient's actions or uttering
the patient's thoughts. The patient may «hear» short or long phrases, indistinct mumbling, whispering, etc.
Classification of schizophrenia
By type of course (progrediency)
1. Continuous
• juvenile malignant
• slowly progredient
• moderately progredient
2. Episodic with progredient course (shift-like [shuboobraznaya])
• with hallucinatory-delusional episodes
• with affective-delusional episodes
• with depressive-depersonalization episodes
3. Periodic (recurrent)
• schizoaffective
• catatonic-oneiroid
• febrile (hypertoxic)
By clinical forms
1. hebephrenic – negative hebephrenic disorders
2. simple – negative disorders, negative and hallucinatory-delusional disorders
3. paranoid – negative and affective-delusional disorders
4. circular – negative and catatonic disorders
5. catatonic – catatonic disorders and pronounced phenomena of autointoxication.
Diagnostic criteria (according to ICD-10) for paranoid, hebephrenic, catatonic, and undifferentiated schizophrenia
Throughout most of a psychotic episode lasting at least one month, at least one of the symptoms
listed in list (1), or at least two symptoms from list (2), must be present.
List 1:
1. thought echo, thought insertion or withdrawal, thought broadcasting;
2. delusions of control or influence, clearly referring to thoughts, actions, movements, or sensations; delusional perception;
3. hallucinatory «voices» commenting on the patient's behavior or discussing him among themselves; other types of hallucinatory «voices» coming from some part of the body;
4. persistent delusional ideas that are culturally inappropriate and completely impossible in content, such as identifying oneself with religious or political figures, claims of superhuman abilities (for example, the ability to control the weather or communicate with extraterrestrials).
List 2:
1. hallucinations of any kind, if they occur daily for at least one month and are accompanied by delusions (which may
be unstable and unstructured) without distinct affective content;
2. neologisms, breaks in thinking leading to incoherence or inconsistency in speech;
3. phenomena of catatonic stupor or excitement;
4. «negative» symptoms, such as pronounced apathy, poverty of speech, blunting or inadequacy of emotional responses (it must
be evident that these are not due to depression or neuroleptic therapy).
Most commonly used exclusion criteria:
1. If the clinical manifestations also meet the criteria for affective disorders, the criteria listed in list 1 or list 2
must be identified before the development of mood disorders.
2. The disorder cannot be explained by organic brain disease, or by a state of alcohol or drug intoxication, dependence,
or withdrawal; ICD-10 also distinguishes post-schizophrenic depression, residual schizophrenia, and simple schizophrenia.
Schizotypal disorders (also known as schizotypal personality disorders) are a group of mental disorders that are included in the category of psychotic disorders in the DSM-5 diagnostic system (Diagnostic and Statistical Manual of Mental Disorders, 5th edition).
People suffering from schizotypal disorders usually display strange, eccentric, or unusual behavioral and cognitive features, which may include:
Strange or unusual thinking: People with schizotypal disorders may experience unusual thoughts, associations, or beliefs that may differ from generally accepted ones.
Eccentric behavior: They may behave in an unusual or strange manner, avoid social events or communication, exhibit social isolation, etc.
Lack of social connectedness: People with schizotypal disorders may experience difficulty establishing and maintaining close relationships with others.
Exalted thoughts and beliefs: There are transcendent or mystical beliefs that may be unconnected to reality.
Heightened perceptual sensitivity: Delusions about external events, sensations, and perceptions may occur.
Oddities in speech and communication: They may use unusual or strange words and phrases, as well as display difficulties in communication.
It is important to note that schizotypal disorders do not necessarily lead to a person developing full-blown schizophrenia. However, people with schizotypal disorders have an increased risk of developing schizophrenia or other mental disorders.
The main precursor of this entity is the concept of «latent schizophrenia» by Eugen Bleuler, who described patients here with mild symptoms of schizophrenia who did not show a tendency toward the classic deteriorating course described by Kraepelin. These conditions subsequently received various designations — ambulatory, borderline, neurosis-like and psychopathy-like, sluggish schizophrenia[2]. The concept of «schizotypal disorder» gradually evolved[4]:
In the American classification (the «Diagnostic and Statistical Manual of Mental Disorders»), schizotypal disorder first appeared in the 3rd edition of the manual — DSM-III (1980). Starting with this edition, «latent», «borderline» (English borderline), or simple schizophrenia were excluded. For these cases, it was proposed to use the diagnosis of schizotypal personality disorder. The term «schizotypal» was introduced by Sandor Rado[English], and derives from an abbreviation of «schizophrenic phenotype», which relates to the assumption that this is a characterological phenotypic variant of the schizophrenic genotype[19]. In the DSM, schizotypal disorder belongs to Axis II — personality disorders — and is considered a pathology of character rather than a mental illness in the strict sense of the word[20]. It is described that this disorder is characterized by «various oddities of thinking, perception, speech, and behavior that are of insufficient severity to meet the criteria for schizophrenia»[20].
In the International Classification of Diseases, 9th revision (ICD-9), there was heading 295.5 — «latent (sluggish, low-progressive) schizophrenia». In ICD-10, sluggish schizophrenia was abolished, but its equivalent appeared — schizotypal disorder (F21). At the same time, in the ICD-10 as adapted for use in the Russian Federation, it is possible to indicate the subtype of schizotypal disorder with a fourth character, for example F21.1 — latent schizophrenia, F21.3 — pseudoneurotic (neurosis-like) schizophrenia, F21.4 — pseudopsychopathic (psychopathy-like) schizophrenia, F21.8 — schizotypal personality disorder, and others.
Treatment of schizotypal disorders usually includes psychotherapy and, in some cases, medication to manage symptoms. It is important to seek help from qualified specialists in a timely manner if you or someone close to you is suspected of having a schizotypal disorder, in order to ensure early diagnosis and appropriate treatment.
Diagnostic criteria for schizoaffective disorder (per ICD-10)
1. Meets criteria for an affective disorder of moderate or severe degree
2. During most of the time over a two-week period, at least one of symptoms «a», «b», «c», «d» from list 1, or
symptoms «b», «c» from list 2 of the diagnostic criteria for schizophrenia, is clearly present
3. Criteria for groups A and B must be identified during the same episode and, at least for some period, simultaneously
4. The most commonly used exclusion criteria: the disorder cannot be explained by organic brain disease, or by a state
of alcohol or drug intoxication, dependence, or withdrawal
Diagnostic criteria for schizotypal disorder (per ICD-10)
For at least two years, continuously or periodically, at least 4 of the following features must be present:
1. inappropriate or constricted affect, the patient appears cold and detached;
2. oddities, eccentricity, or peculiarities in behavior or appearance;
3. impoverishment of contacts and a tendency toward social withdrawal;
4. strange views (beliefs) or magical thinking that influences behavior and is inconsistent with subcultural norms;
5. suspiciousness or paranoid ideas;
6. obsessive rumination without inner resistance, often with dysmorphophobic, sexual, or aggressive content;
7. unusual perceptual phenomena, including somatosensory (bodily) or other illusions, depersonalization, or derealization;
8. vague, circumstantial, metaphorical, overly detailed, and often stereotyped thinking, manifested in odd speech (or otherwise) without pronounced incoherence;
9. rare, transient psychotic episodes with intense illusions, auditory or other hallucinations, and delusion-like
ideas, usually arising without external provocation;
10. the diagnostic criteria for schizophrenia have never been met.
Diagnostic criteria for delusional disorder (per ICD-10)
1. The presence of delusions or a system of interrelated delusional ideas, excluding those specified in points b) and d) of list 1 of the criteria
for group A of schizophrenia (i.e., excluding those completely impossible in content or culturally inappropriate). The most common examples: delusions of persecution, grandeur, hypochondriacal, jealous, or erotic delusions
2. The delusion (criterion A) must be present for at least 3 months
3. The general criteria for schizophrenia are not met
4. There should be no chronic hallucinations of any kind (though transient or occasional auditory hallucinations may occur, in which the patient is not discussed in the third person and which are not of a commentating nature)
5. Depressive symptoms may be identified from time to time, but the delusional ideas persist even at times when mood disturbances are
not present
6. The most commonly used exclusion criteria: the disorder cannot be explained by organic brain disease or by the use of
psychoactive substances
Autism spectrum disorders are distinguished by more severe impairment of interpersonal contacts, as well as stereotyped interests and behavior[37].
Schizoid and paranoid personality disorders (with observed social withdrawal) are distinguished by the absence of oddities in behavior, eccentricity, and cognitive or perceptual distortions[37].
Social withdrawal and suspiciousness in narcissistic personality disorder are related to fear of revealing one's imperfections[37].
Borderline personality disorder is characterized by manipulative and impulsive behavior[37].
Avoidant personality disorder is distinguished by an active desire for personal relationships, limited by fear of rejection or embarrassment[37].
Schizophrenia, delusional disorder, bipolar I or II disorder with psychotic features, and depressive disorders with psychotic features are distinguished from schizotypal personality disorder by a period of persistent presence of psychotic symptoms[37]. To make an additional diagnosis of schizotypal personality disorder in the presence of these disorders, the personality disorder must be present in a state of remission and prior to the onset of psychotic symptoms[37].
Chronic delusional disorders (also known as chronic paranoid disorders or chronic psychotic disorders) are a group of mental disorders in which delusional thinking and beliefs predominate. These disorders are characterized by the long-term and persistent presence of delusional beliefs without clear periods of remission or obvious symptoms of other mental disorders.
Some of the chronic delusional disorders include:
Chronic delusional disorder (chronic paranoia): Characterized by persistent delusional beliefs, often associated with suspiciousness, persecution, or distrust of others.
Chronic hallucinatory disorders: Involve the prolonged presence of auditory (heard) or visual (seen) hallucinations, which may be associated with delusional thinking.
Chronic delirious disorders: In this category of disorders, delirious beliefs predominate and may be relatively stable over time.
Chronic delusional disorders can significantly affect a person's behavior, functioning, and quality of life. People suffering from these disorders may experience social isolation and difficulties in establishing and maintaining relationships with others.
Treatment of chronic delusional disorders usually includes psychotherapy and medication to manage symptoms. It is important to seek help from qualified specialists to ensure adequate diagnosis and to determine the best treatment plan for the specific case. As with other mental disorders, early help-seeking can significantly improve the prognosis and quality of life of a person suffering from chronic delusional disorders.
Induced delusional disorders (also known as induced psychotic disorders) are mental disorders that develop in a person as a result of exposure to or influence from another person or environment. In these cases, psychotic symptoms, including delusional beliefs and hallucinations, can arise under the influence of external factors.
Induced delusional disorders can occur in the following situations:
Folie à deux: Also known as Lasègue–Falret syndrome, this is a condition in which a person shares the delusional beliefs or hallucinations of another person, usually a close person or an authority figure. A person suffering from folie à deux may perceive and adopt another person's delusional beliefs as their own.
Induced delirium: This is a condition in which a person may share or adopt the delirious beliefs of another person or group of people.
Induced hallucinations: When a person begins to experience hallucinations under the influence of another person or group, for example, as a result of indoctrination or manipulation.
Induced delusional disorders are usually associated with interpersonal interactions and external influence that can affect a person's mental state. This must be distinguished from the use of drugs or psychoactive substances, which can cause temporary psychotic symptoms, but in that case are referred to as drug-induced psychotic disorders.
Treatment of induced delusional disorders often includes psychotherapy and supportive therapy, as well as limiting contact with the people who may be responsible for inducing the psychotic symptoms. It is important to seek help from qualified specialists for diagnosis and to determine the best approach to treating such disorders.
Schizoaffective disorders are a group of mental disorders that combine symptoms of schizophrenia with symptoms of affective disorders, such as bipolar disorder or depressive disorder. These are complex and rare mental conditions that combine elements of both types of disorders.
To diagnose schizoaffective disorders, at least two key criteria must be present:
It is important to distinguish schizoaffective disorders from pure forms of schizophrenia or affective disorders, since their management and treatment may differ. People with schizoaffective disorders may experience severe episodes of psychotic symptoms combined with mood changes, which requires a comprehensive approach to treatment.
The exact causes of schizoaffective disorders are unknown, but their development is linked to genetic, biological, and environmental factors.
Treatment of schizoaffective disorders usually involves a combination of medication, psychotherapy, and supportive therapy. It is important that treatment be conducted under the supervision of qualified specialists, since this type of disorder can be complex and requires an individualized approach for each patient.
In addition to schizoaffective disorders, there are several other nonorganic psychotic disorders characterized by the presence of psychotic symptoms (such as hallucinations, delusional beliefs, disorganized thinking, and others) but not associated with schizophrenia. These disorders can be caused by various factors, such as stress, drugs, medical conditions, or other mental disorders. Some of the nonorganic psychotic disorders include:
Psychotic disorder caused by a medical condition: This is a psychotic state that arises as a result of medical problems or physical illnesses, such as brain tumors, infections, or other diseases that affect brain function.
Psychotic disorder caused by drugs or alcohol: Drug or alcohol use can cause temporary psychotic symptoms in some people.
Psychotic disorder caused by stress: Extreme or prolonged periods of stress can be associated with the emergence of psychotic symptoms.
Psychotic disorder caused by other mental disorders: Some mental disorders, such as depression with psychotic features or bipolar disorder, may also be accompanied by psychotic symptoms.
Treatment of nonorganic psychotic disorders depends on the underlying cause. In some cases, when psychotic symptoms are caused by medical problems or drug use, treatment may include medical procedures or addiction treatment. In other cases, psychotherapy and medication may be used to manage symptoms. It is important to conduct a comprehensive evaluation and diagnosis under the guidance of qualified specialists to determine the best treatment plan for each individual case.
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