Diagnosis of low-grade schizophrenia. How to recognize low-grade schizophrenia? Sluggish schizophrenia: causes

In medical reference books, sluggish schizophrenia is called a mild form that does not imply a change in character, or a low-progressive form. This definition arose due to the slow, gradual increase in the clinical picture. Sluggish schizophrenia is characterized by a relatively shallow disorder of brain activity. The patient may experience symptoms of neurotic, obsessive-compulsive disorders, hypochondria, and phobias. A small percentage of patients exhibit paranoid disorders.

In the fairer sex, the pathology may intensify during menstrual periods

Depending on age, gender and individual characteristics, the signs of sluggish schizophrenia may differ. In a latent state, the disease can manifest itself with the following symptoms:

it is difficult for the patient to communicate with others;
selfishness, one-sided interests;
autism;
anxiety developing into hysteria;
excessive suspicion.

In some cases, this type of schizophrenia manifests itself in women with hysterical reactions. This could be excessive irritability, tearfulness, causeless pessimism, or disguised depression. Such conditions worsen during PMS. Many patients talk about severe attacks of self-doubt, anxiety, sentimentality, and fear shortly before the onset of menstruation.

Often women themselves attribute such conditions to fatigue and overwork, unaware of the hidden course of mental illness.

With sluggish schizophrenia, relatives may observe uncontrollable activity and the manifestation of altruistic beliefs in the patient. Some conditions that are uncharacteristic for the individual may also be present:

excessive nervous excitability;
unreasonable optimism;
performing ritual actions;
nervous tics;
changes in mood, which manifests itself as fears, fussiness, and insomnia.

In men, sluggish schizophrenia can manifest itself with one single symptom - an isolated reaction to external stimuli. They may be delusional, hysterical, depressive or hypochondriacal. The irritant may be the loss of a highly valuable idea or object.

Signs of low-grade schizophrenia may appear after the loss of a relative or friend who was indifferent to the patient during life. During such a period, a persistent depressive state develops, a decline in mood and strength, melancholy appears, and the patient is overcome by thoughts about the meaninglessness of existence.

The hypochondriacal reaction to the trigger is suspicion. Often the patient believes that those around him are gloating, rejoicing at his failures, and it seems to him that everyone around him is looking at him with ridicule.

When the active phase of low-grade schizophrenia begins, the attacks become prolonged and are accompanied by prolonged depression with impaired thinking. In elderly patients, the clinical picture shows increased anxiety, delusions of jealousy, and hysterics.

Stages of development

The disease can be clearly and clearly recognized, to a greater extent, in middle age

It is impossible to diagnose low-grade schizophrenia in childhood or adolescence, since its signs are completely erased. As a rule, the disease manifests itself after 20 years. The development of a condition is determined by its main stages of development:

Latent or hidden period. There are no obvious schizophrenic signs in its course.
The period of active development of the disease. Signs of sluggish schizophrenia in men and women increase gradually, but confidently, and attacks begin.
Stabilization period. Personal changes are consolidated and take root.

The clinical picture of the disease is represented by the following symptoms and features:

the latent stage is usually long;
symptoms change gradually;
characteristic signs appear periodically, each time growing more and more (obsessive states, disturbances of self-awareness, overvalued ideas).

At the stage of the latent course of the disease, the patient not only has no noticeable signs, but may even experience career growth and success in the personal sphere. Minor mental disorders are not perceived by either the patient or his relatives as alarming signs.

When sluggish schizophrenia enters the active stage, attacks of inappropriate behavior begin, negative personality changes, delusional and obsessive ideas appear. Often outbreaks are associated with age-related changes. After the attack phase, a stable remission usually occurs.

At the first symptoms of the disease, you should contact an experienced specialist to make the correct diagnosis and prescribe a course of treatment.

Diagnosing the varieties of this form of schizophrenia is one of the most difficult tasks. The doctor must be able to distinguish an endogenous process from personality disorders that may be of hereditary origin. Let's look at the types of the disease in more detail.

With symptoms of obsession

This variety is typical for individuals with suspicious characters. In latent form, the patient manifests fears, obsessions, and anxiety. For example, a patient may be hysterically afraid of heights, darkness, people, the evil eye, damage, etc. When the disease becomes active, obsessive phenomena are the main basis for making a diagnosis of low-grade schizophrenia. As a rule, such conditions are long-term and remissions are incomplete; attacks occur against a background of depression, often reminiscent of insanity.

If we compare sluggish schizophrenia with neurosis, then the first has a characteristic distinctive manifestation: the patient is accompanied by constant doubts about the correctness of his actions, he suffers from an ambivalent attitude towards someone (hate and love). Such an attack can last for several years, manifesting itself with the following symptoms:

lack of motivation;
fear of going crazy;
obsessive hobbies;
contrasting, polar thoughts;
fear of harming yourself or loved ones;
fear of fatal diseases.

After some time, phobias become ridiculous, fears reach the point of absurdity. The patient begins to perform various rituals, feels helpless and needs the support of loved ones.

With symptoms of depersonalization

This form of sluggish schizophrenia is accompanied by disturbances in self-awareness. The disease is typical for men, and the first signs of the disorder begin in adolescence. Among the main signs:

shyness and reticence;
impressionability;
dissatisfaction with oneself;
coldness towards others;
somatic changes: change in gait, pain in the bridge of the nose.

As the disease progresses, patients feel that their actions are unnatural. Patients often complain about changes in their condition - it seems to them that their imagination has become worse, the flexibility of their mind has disappeared. Such symptoms of sluggish schizophrenia are accompanied by insensitivity and coldness. Many patients note that they lack empathy, dissatisfaction and satisfaction, and the world has lost its color.

A patient with this form of the disease is not able to soberly evaluate his actions and actions. He perceives everything as alien and meaningless, and may not even understand speech and gestures. A person begins to see the world through someone else’s eyes against the background of personal rejection.

With symptoms of hypochondria

The disease may be accompanied by insomnia

This variant of the disease is usually detected in those patients who have a tendency to hysteria. Since childhood, such people are not confident in themselves and are very suspicious. As children, they are sensitive to weather changes, suffer from digestive problems, migraines, allergies and dizziness. Due to the emergence of somatic diseases to the fore, the picture of this disease is blurry.

Growing up, the child begins to complain about deterioration in health, health problems, and the presence of incurable diseases that are not detected during a professional examination. The following vegetative disorders may occur:

chills;
slow heart rate;
dyspnea;
excessive sweating;
sleep disorder;
nausea;
temperature increase within insignificant limits.

Due to the development of autonomic disorders, sensitivity disorders, bulimia, and pain in various organs may occur. Such patients are constantly monitored by doctors, and in some cases schizophrenia cannot be diagnosed. Sluggish schizophrenia often occurs in women and men who are indecisive and suspicious by nature.

The characteristic psychological symptoms of the disease are:

tearfulness;
motor disturbances such as unexplained severity;
irritability;
pessimism.

As the disease progresses, patients develop uncertainty, fatigue and asthenia. During exacerbations, fear of death may develop. The patient is unable to assess his condition and calls an ambulance, requiring immediate hospitalization.

With manifestations of hysteria

The symptomatic picture begins to appear in childhood

Patients suffering from this form of the disease are usually unbalanced and very impulsive. They are often capricious and prone to hysterics, which develop in childhood. Moreover, most of these people are creatively gifted.

As a rule, the first signs of the disease appear already at 10 years of age. The child becomes complex, suspicious, and signs of expressiveness appear in his behavior. Such children often fantasize, wishful thinking.

It turns out to be very difficult to distinguish an ordinary dreamer from a potentially sick person at an early age. That is why the disease in most cases is ignored and neglected.

With age, such a person can turn into a domestic tyrant. His behavior is characterized by intemperance, he is capable of throwing such emotional scandals that he can lose consciousness from overexcitement. Minor stress can turn into a storm of emotions, leading to the development of feelings of lightheadedness, dizziness and speech disorders.

Sluggish low-symptomatic schizophrenia

Signs of the disease often appear vigorously after 20 years of life. Patients experience the following symptoms:

decreased mental activity;
lack of initiative;
obsessive-compulsive disorders;
monosyllabic speech;
emotional poverty;
asthenia.

Despite such deviations, patients have professional skills until old age and can work. Outwardly, people are calm and do not show aggression towards others or themselves. It is difficult to diagnose the disease in this variant, therefore treatment of low-symptomatic, sluggish schizophrenia is practically not carried out.

Treatment

Treatment of sluggish schizophrenia should be comprehensive and involve drug therapy and psychotherapeutic influence. Specific drugs are selected by a specialist based on the patient’s health condition and the degree of disease progression.

Drug treatment

You should take one or two tablets during the day: morning or evening

Traditional antipsychotics and atypical neuroleptics are used, other groups of drugs are added occasionally.

Traditional drugs block dopamine receptors, thereby achieving a general antipsychotic effect. These are Haloperiodol, Chlorpromazine, Thioridazine and the like.

Atypical antipsychotics act on both dopamine and serotonin receptors. They have significantly fewer side effects, and their use does not interfere with family life or work. These are Risperidone, Olanzapine, Clozapine, Quetiapine and the like.

Psychotherapy

Its possibilities are limited due to the fact that deficiency disorders are the outcome of the disease, its result.

All a psychotherapist can do is try to teach a sick person how to interact correctly with the outside world. Such treatment of low-grade schizophrenia is carried out during cognitive behavioral therapy. However, an obstacle to psychotherapeutic work is the fact that the patient does not consider himself sick. It is difficult to argue with him, especially if the person has never been hospitalized.

Changes in character and lifestyle are visible to others, but are not at all obvious to the patient himself. It’s much easier with those who have been in the hospital at least once. They were initially well treated, and had the opportunity to contact someone who received disability due to mental illness. Naturally, they strive to avoid such a fate.

There is psychiatry, psychiatric problems arise - psychoses and other disorders. This is the case when the concept of “deterioration in quality of life” acquires such features that it becomes noticeable during a routine visual examination of the patient. It is enough to look at him to understand the situation. In the majority of patients with serious disorders, this quality simply cannot help but deteriorate. At the same time, the lives of those around him change for the worse.

Symptoms of low-grade schizophrenia do not appear immediately

Everything should be simple: if there is psychosis - psychiatry, but if there is no - somewhere else...

The patient may persist, declare that he is completely healthy and that some kind of arbitrariness is being done to him. Only, if behind this person the actions are strange and full of a complex of aggression and protest, then it will be better for everyone if the application of an adequate treatment regimen nevertheless begins. The scales of diagnosis weigh the degree of suffering. And the forecast, in general, should be made in relation to this degree - its increase or decrease.

The bad thing is that some antipsychotics, along with a decrease in mental activity, also significantly reduce mental and physical abilities, but they are prescribed when, the day before the start of therapy, the patient used a large gas key to drive out evil spirits from the pipes or throw feces at passing trains, following the instructions of the voices in my head.

Everything is clear here. There is suffering, and there is at least some method of escape. Neuroleptics are not candy, but in real, selected and obvious cases of psychiatry they are necessary. Nearby there is another layer of existence. This is a world of unconventional personalities, autistic thinkers, ambivalent connoisseurs of the beautiful and the ugly, strange behavior, magic and mysticism, avant-garde art and a desire to reform society. Psychiatric intervention is possible, sometimes also necessary, but the criteria themselves cannot be the same as in the case of overt paranoid schizophrenia. We are talking not only about diagnostic criteria, but about the very principle of initializing the process and approach to it. It is impossible to say that the signs of sluggish schizophrenia in men and women do not deserve the attention of psychologists in general, including representatives of religious teachings. It is clear that psychotherapists will have something to work with. Not to treat something, but to work with something...

Latent schizophrenia, what is it...

Why and why did the WHO, which manages the process of revisions of the ICD, include the diagnosis of “latent schizophrenia” in class V? It is understood that the patient himself assesses his condition as negative, experiences suffering and seeks help. A doctor cannot provide it just like that, neither in Germany, nor in the USA, nor in Russia. We need a diagnosis. But, fortunately, it is far from block F20. Then block F21 “Schizotypal disorder” was created. There are two types of “similarities” that fall into this category. These are diagnoses starting with “pseudo” - pseudoneurotic and pseudopsychopathic schizophrenia, as well as latent, “poor in symptoms”, schizotypal personality disorder and a special schizophrenic reaction.

Latent schizophrenia symptoms have an exclusively non-psychotic profile. Differentiating it with schizotypal personality disorder is almost impossible in practice. Offhand, you can name five diagnoses from completely different categories, which can also be suitable for some individual case.

The disorder was once designated and is sometimes still designated by the concept of “sluggish schizophrenia.” It is connected with two facts. This is the use of an approach to imprison in IPA all those disliked by the authorities and to search for the prodrome of ordinary paranoid schizophrenia in some milder forms.

Sluggish schizophrenia is not associated with schizotypal disorder

It is quite possible that this prodrome exists. But only in order to develop the correct attitude to the situation, you need to finally understand what “splitting consciousness” is, and then develop actions. It is necessary to apply some kind of therapy to people with a serious disconnect from reality now. In other cases, haste is far from related to the construction of an adequate treatment regimen.

The presence of psychosis is not so difficult to establish

Let us outline the picture as it seems correct from the practical side. This is a quick diagnostic that is carried out from the very beginning. Let's imagine a completely peaceful situation. We will omit the “combat” path, with bindings, injections right in the ambulance, screaming, handing over patients to a special brigade by police officers, because then the situation speaks for itself.

Let it be a local psychiatrist and a person who came himself. What does the doctor ask first? A standard set of questions is used, and the answers show a person’s ability to assess the situation, the situation, and identify himself. The presence of hallucinations, pseudohallucinations and delusions is established. If possible, information received from the alleged patient is supplemented with information from relatives. While in cursory mode, this is not yet a detailed history of life and condition, but simply clarification of the very nature of the case. The psychiatrist will also inquire about head injuries and other possible reasons for the appearance of some organic changes.

Whether the person came to the specialist himself, or was persuaded by relatives, or lured by deception, but in 30 minutes you can establish the very essence: whether there is psychosis or not. What it is, how it proceeds, what needs to be excluded, what to add - this is all determined during long-term observation. No psychosis? Shouldn't you go to a psychotherapist? It heals the soul and is relatively inexpensive.

Now let's imagine a situation with various vague oddities.

Doctor, sometimes strange thoughts come into my head. It seems to me that the world has turned against me.
I think that I did something terrible at some point in the past, and now I will inevitably face retribution.
I can't stay alone. I feel terrible, like the walls are trying to crush me. What should I do?

All these statements may hide a variety of diagnoses. This is what he said about the world’s militia against him - it is possible that if we let him talk more, he will begin to tell such things that we will see clear signs of delusions of persecution and influence. But, again, in the interpretations of a psychiatrist. Or maybe he doesn’t even have depression, he’s completely healthy and there’s no question of any diagnosis here.

Therefore, psychosis is identified according to criteria that clearly indicate its presence.

Diagnosing a disorder without psychotic symptoms is even easier

During the years of the USSR, it was enough to see a guy with an earring in his ear, long hair and torn jeans. Symptoms of “sluggish” schizophrenia within the framework of psychosis may not be detected. Therefore, a diagnosis can be made to anyone, even if the person tries to cheat and is laconic.

Scientists, doctors and members of the public who work at WHO have added a separate block to the ICD for diagnosing all sorts of oddities, not out of malicious intent. This is only an attempt to regulate the activities of psychiatrists and psychotherapists in cases where help is needed or desired. Psychiatry is a special type of medical practice. Diagnosis follows treatment. All haloperidol passions that are related to paranoid schizophrenia are almost always, in almost all cases, justified by the situation itself. At least we know that voices are not a joke, and they do not seem, but are part of the “reality” of the patient’s psyche. And measures need to be taken... Those that can reduce the degree of damage from the disorder.

If desired, symptoms of low-grade schizophrenia can be found in anyone - so you cannot make a diagnosis yourself

But these things, when some kind of moderate schizophrenia occurs, do not give such confidence in the justification of psychiatric intervention.

Signs of low-grade schizophrenia allow anyone to be diagnosed. Differential diagnosis of “sluggish” schizophrenia is possible only in terms of separating it from organic disorders and more serious syndromes associated with a malignant course. It is either very difficult or impossible in principle to separate it from everything else, including the normal state. The only difference between “sluggish” schizophrenia and the simple form of schizophrenia is that these are two controversial diagnoses, but the simple form is found at the age of 14-20 years, and the “sluggish” form is found in any person.

You, personally, can be diagnosed in 20 minutes, and substantiated in 10. It cannot be ruled out that if it doesn’t work out, then the examination period can be increased to 40 minutes. But in an hour you will not be left without a diagnosis. Tough? What did you want if psychotic symptoms are excluded in fact? What then are they considering? This is the main secret... Diagnosis reveals prepsychotic and prodromal schizophrenia. Until the premiere, all persons diagnosed with paranoid schizophrenia were normal. They were given the right to drive vehicles, recruited to serve in the army and government agencies, they were ordinary, no different from other citizens. But somehow all this developed in them... This non-difference is “pre”, “prod”... It is enough to look at the norm from a different angle, and it will become a special sluggish, light, soft and some kind of schizophrenia.

This does not deny the existence of the problem itself, but it does indicate that approaches to its consideration are controversial.

At the same time, strange as it may seem, everything said above is not an attempt to deny the existence of the problem of schizophrenia itself without its main symptoms. A pure prodromal state, if noticed by the patient himself and assessed as a source of discomfort, is a consequence of a general integral disorder. It concerns metabolism, energy-informational metabolism, it is associated with the initial diathesis, it also indicates that the information exchange has been disrupted, and this is somehow connected with

activity of the higher nervous system;
work of the psyche;
features of thinking.

The moment when the patient managed to notice the prodrome just indicates that his thinking has “broken.” The “mechanism” itself... Sometimes in Orthodoxy the mind is called the “eye” of the soul. So the person felt that the “eye” began to “see” worse. Everyone expresses this differently. It was not by chance that Bleuler described this latency; it was not by chance that he spoke of the prodrome of the latent form. And in fact, all this can lead to hallucinations. But you can only treat them differently.

Hallucinations and delusions are a way for the unconscious to establish contact with consciousness. This is a defensive reaction and, at the same time, a way for the psyche to self-heal. What is “fixed” at the moment of activation of hallucinations is precisely the ability of thinking to interpret and compile information. The unconscious splashes out into consciousness the constructive elements of its language, even if they have the appearance of devils - these are the images that it is rich in, it has no others, but their role is much more positive than it might seem. Of course, consciousness interprets elements of the unconscious as some kind of phenomena - voices, alien lizards and the like. But this is all in the case of the paranoid form. Symptoms and signs of “sluggish” schizophrenia are softer things, some kind of imperceptible transactions of information from the unconscious to consciousness. This does not change the general principle. The process of mental self-regulation began, and once it began, it did not happen out of nowhere. Treatment of “sluggish” schizophrenia is a real attempt to block the action of the immune system of the body itself.

Weaknesses of psychiatry

One of the weakest points of psychiatry is that it presents the consequence of something in the form of the disorder itself, and by treatment they mean the elimination of the consequences. This is the same as treating a boil by applying the tightest bandage - as long as not a drop of pus gets on the sheet. Why do they talk so much about behavior in these “sluggish” and other “mild” forms? Because something obvious is needed... It is absolutely wrong to consider the behavior of all supposed patients to be non-standard in external terms. Let's put it this way - more often than others, you notice individuals who are original, communicate differently, dress differently, see the world differently and talk about it. Autistic people hid in their own holes, and no one knows about them. In fact, there are many more autistic people than there are eccentrics and public performers.

Original and eccentric does not mean schizophrenic

The obvious strangeness of psychiatry is that not only practicing ordinary doctors, but also scientists allow themselves to think the same way as people on the street. Prodromality is called an “alarm bell” and it is believed that if it is recognized in time and treatment is started, then deeper and more serious forms can be avoided. Delusions and hallucinations are perceived as serious, which in reality are a protective and restorative reaction of the psyche and the entire body to the violations occurring in it. Hallucination is a tool of the psyche, not a devil on the broom. By blocking mental activity at the level of influence on neurotransmitter receptors, hallucinations disappear. In some cases, this is necessary. The unconscious - it cannot itself correlate the level of its interference in consciousness. His activity is somewhat reminiscent of the elements. Nevertheless, the entire set of elements of the human device does its job.

Due to some problems, the psyche and thinking are transferred to a mode that is most consistent with maintaining vitality in an extreme situation of disruption of energy-information metabolism.
The process of self-correction, restructuring, and adjustment to the emerging conditions begins. During this process, the information processing mechanisms of consciousness and the unconscious temporarily merge.
With the right attitude to what is happening, attempts not to block neurotransmitter receptors, but to give the body something that will strengthen its immune abilities, the prime minister does not entail the development of a defect. The same is possible in the case of ordinary inaction, but when the person is placed in a gentle environment.

In this context, the question of whether low-grade schizophrenia can be cured seems the most “smart.” Is it possible to block the best, most gentle response of the body and psyche to metabolic disorders, without delusions and hallucinations at all, in the same way as hallucinations are blocked? Yeah. It is possible... It is possible to find such substances and such therapy that a person will not be able to think at all. Everything is quite real.

And about another killer argument. It is believed that about 40% of such patients attempt suicide. Hence the conclusion is that life expectancy in low-grade schizophrenia is low, so something needs to be done urgently. I talked with one supporter of Soviet theories from the time of Snezhnevsky. Authoritatively and powerfully proved the presence of sluggish schizophrenia. And you know, he convinced me. What's the point? He did not equate the term “sluggish” with the concept “latent”. He described 3-4 case histories of the most common paranoid schizophrenia, but without an increase in symptoms, with low progression. Everyone experienced hallucinations, delusions, a decrease in affect and its flattening, but they did not dance naked under the moon, although the patients ended badly. Here is an example of the ornateness of psychiatry terminology in terms of interpretation. It is necessary to prove the presence of a “sluggish” one, then they pass it off as paranoid. The malignancy of the episodes themselves does not bother me at all. Old school of Soviet psychiatry. However, it cannot be denied that paranoid schizophrenia can be sluggish. But this doesn’t make her any different, she’s just paranoid with low progress in pathogenesis.

Instead of output

The problem of thinking disorder exists... It can lead to anything, from autism with elements of agoraphobia to eccentric behavior without a decrease in social activity. However, the only reason for starting treatment in terms of psychiatry is the desire of the patient himself. It makes more sense to make any other diagnosis that contains the word “neurosis.” It is better to abstain from medications as long as possible.

A psychotherapist will help you fight neuroses

It is better to make an exception only for antidepressants if the patient is experiencing depression or something related to anxiety. And in all other respects, psychotherapy is broad, deep and sometimes effective. It’s her methods that you need to rely on.

Schizophrenia is a psychotic disease that is accompanied by a disorder of thought processes and disturbances in emotional response. One of the varieties of this mental disorder is sluggish schizophrenia. Its distinctive feature is its slow progression and blurred symptomatic picture. Treatment of sluggish schizophrenia is a long and painstaking process.

Symptoms of low-grade schizophrenia

The patient exhibits disturbances in mental activity, spheres of perception, and signs of paranoia appear.
- Manifestations of this disease are hysterical fits, accompanied by sobs and often self-harm. Personality disorders are also observed: a manic desire for universal admiration, pointedly defiant behavior, unreasonable mood swings; physiological changes - unsteady gait, tremors of the limbs during excitement.
- Often patients have an obsessive idea about their incurable illness or impending death.

Sluggish schizophrenia signs: in addition to the above symptoms, this disease can manifest itself in others. For example, patients may exhibit an overly pronounced desire for solitude, suffer from various phobias, experience unreasonable anxiety, and get tired too quickly.

Stages of progression of low-grade schizophrenia

1. Initial (hidden) stage– proceeds quite unnoticed, symptoms are mild; The patient may experience prolonged depression and states of passion.
2. Active stage. At this stage, the patient is plagued by panic attacks, unreasonable fears, his behavior becomes strange, but hallucinations and delusions do not yet appear.
3. State stabilization stage. Sluggish schizophrenia practically does not show symptoms at this stage; they are observed to subside. This stage can take a long time.

Treatment of low-grade schizophrenia

Treatment for a patient with a similar disease is primarily prescribed medication. When taking medications, you must strictly adhere to the doctor's instructions, as the effectiveness of the treatment depends on this. Treatment of low-grade schizophrenia is not limited to medications. Such a patient needs psychological support from a specialist (trainings, professional rehabilitation) and loved ones.

Sluggish schizophrenia is also called low-progressive, non-psychotic, microprocessual, rudimentary, hidden, larved, etc. The main feature of this form is slow progress, with indirect manifestations of the clinical picture. The pathology is not characterized by productive symptoms; the clinical picture is based on neurotic disorders, partially negative signs with shallow personality changes.

Stages of the pathology

As a rule, sluggish schizophrenia begins its debut in adolescence, but since its signs are weakly expressed, the pathology can be recognized after a considerable time.

This type of schizophrenia is characterized by stages in the manifestation of symptoms. Pathology is conventionally divided into three periods:

debut or latent period;
manifest or active phase;
stabilization.

The onset is unnoticeable, the symptoms are relative. Depressive states may occur, accompanied by isolation and a person’s withdrawal into his own invented world. Various ideas begin to arise, the patient is prone to abstract thinking, philosophizing, which has no values.

The debut gives way to the manifest; during this period, the symptoms of the disease clearly begin to appear and, as a rule, a diagnosis is established. During this period, absurd fears often arise, for example, a person dressed in a uniform or a purple jacket can cause an unbearable state of horror and a desire to run away. Symptoms such as isolation become more pronounced, it can reach the state of autism, the patient is exhausted, often experiences insomnia, and his range of interests is narrowed.

The manifestation can occur with different clinical signs; neuroses, paranoia, hysteria, obsessive-compulsive disorder, hypochondria, and others may predominate. Also, low-grade schizophrenia has a history of one or two of the following defects:

Verschreuben, the main sign of this defect is strange behavior, pronounced foolishness, eccentricity, eccentricity. This behavior is expressed in sloppiness, awkwardness in appearance, for example, the patient can wear shorts with a down jacket in the summer, etc. His movements are uncertain, angular, reminiscent of a small child, but he does it all with a serious look. Changes are also observed in speech, it is full of all sorts of pretentious turns of phrase, the patient speaks quickly and not to the point, dangling thoughts are often observed, he begins his story with one thing, forgetting what he was talking about at the beginning, jumps to another topic of conversation. At the same time, everything remains, mental and physical activity is preserved;
pseudopsychopathy - this defect is expressed in a large number of different ideas in the patient, which he considers extremely valuable and does not tolerate any criticism on this matter. The patient is emotionally excited and involves everyone around him to implement his brilliant ideas. Naturally, the result of such actions is negligible or non-existent;
a reduction in energy potential manifests itself in depression, self-isolation, lack of any motivation to do anything, a desire to spend time alone, and isolate from society.

The stabilization stage is the main goal pursued when treating patients. In fact, this is a remission with partial or complete disappearance of symptoms characteristic of the manifest period. Unfortunately, stable and long-term stabilization is not always possible to achieve, but even without treatment the situation will only worsen, leading the patient to an irreversible personality defect.

General clinical picture

In addition to the three conditions described, low-grade schizophrenia can manifest itself with various symptoms, for example:

Low-progressive schizophrenia and its forms

Sluggish schizophrenia can occur in the following forms:

Personality defect

The most difficult and often irreversible consequence of a long course of schizophrenia is the development of a personality defect. In this case, all human qualities suffer: emotions, will, thinking and intellect.

A personality or schizophrenic defect consists of the following manifestations:

autism;
speech disorder;
impoverishment of the emotional sphere;
inability to adapt to society;
thinking disorder.

All these signs steadily develop in any form of schizophrenia; the sluggish process, unfortunately, is no exception, with the only difference being that such symptoms arise later than in other types of pathology.

Therapy

For the most favorable outcome of schizophrenia, it is important to begin treatment before the onset of the manifest stage. A distinctive feature in the treatment of the indolent form is the use of drugs in relatively small doses compared to other more malignant types of pathology.

For treatment, one drug is determined that is best able to relieve the symptoms of the disease and lead to remission. Slightly progressive schizophrenia is a chronic disease and requires continued treatment even during a period of stabilization and even complete remission. As a rule, they leave the same drug that was used and during the manifestation period they only reduce the dosage to the minimum. The main groups of drugs for schizophrenia are as follows:

neuroleptics of new and old generation;
anxiolytics;
normomitics;
antidepressants;
nootropic drugs;
psychostimulants.

The main drug for the sluggish form of schizophrenia is considered to be a new generation antipsychotic - haloperidol. Less commonly prescribed are classic, typical or previous generation antipsychotics. Their disadvantage is a large number of side effects. Basically, drugs are prescribed orally; medications are administered intravenously or intramuscularly only when it is urgently necessary to stop psychomotor agitation.

Sluggish schizophrenia is treated in most cases on an outpatient basis; less often, during the period of manifestation, the patient may be in a hospital setting. Hospitalization may be indicated in the following cases:

refusal to eat for more than a week;
loss of body weight by more than 20%;
aggressive conditions;
psychomotor agitation;
suicide attempts.

In addition to drug treatment, psycho-emotional support from relatives and doctors is important. Group sessions with a psychotherapist, which involve patients with the same diagnosis, are encouraged. It is important not to criticize the patient’s behavior, but to create psychologically favorable conditions for life.

The prognosis for low-grade schizophrenia is more favorable compared to other forms. Treatment requires smaller doses of medications, and the personality defect occurs slowly and is not pronounced. The main goal in the treatment of pathology is based on achieving high-quality and long-term remission, preferably without repetitions of manifest periods.

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Sluggish schizophrenia in psychiatry is called a low-progressive form. Symptoms of low-grade schizophrenia are distinguished by a relatively shallow disorder of brain activity. The patient has autonomic neurotic disorders, phobias, and hypochondria. Some patients have erased paranoid disorders. The clinical picture slowly increases, so in the medical literature the disease is called mild schizophrenia without changes in character.

Stages of development of low-grade schizophrenia

Most often, sluggish disease is not diagnosed due to blurred signs. The disease debuts in young people after twenty years of age. The development of pathology can be determined by the main periods:

A latent period during which there are no obvious signs.
Active (full development of the disease). It occurs continuously and manifests itself in a series of attacks.
Stage of stabilization with personal changes.

The main clinical signs of the disease are:

long hidden stage;
gradual change in symptoms;
circular course with characteristic symptoms: obsession, disorder of self-awareness, overvalued ideas.

In the latent stage, the patient does not show characteristic signs. Career growth is possible in the professional field. Some behavioral disorders are not regarded by the patient and his relatives as a mental illness. Therefore, during this period, pathology is very rarely diagnosed. Some symptoms and signs of sluggish mental illness are never recognized, and mental illness only makes itself felt in old age.

During the active period of the disease, attacks of inappropriate behavior appear. Patients may experience negative personality changes and delusional ideas. Typically, outbreaks are associated with age-related changes. After an attack, stable remission is possible.

Characteristic signs of low-grade schizophrenia

During the latent (latent) period of the disease, people may experience the following symptoms:

difficulties in contact with others;
autism;
selfishness;
hysteria;
anxiety;
one-sidedness of interests;
suspicion.

Signs of sluggish schizophrenia in women sometimes manifest themselves in hysterical-type reactions, which are followed by periods of causeless pessimism, tearfulness, and irritability. In women, exacerbation occurs before menstruation (premenstrual exacerbation). During such periods, patients report severe attacks of self-doubt, sentimentality, anxiety and fear. Typically, women regard this condition as overwork and do not associate it with mental illness.

Sometimes people develop uncontrollable activity and overvalued beliefs. In such cases, relatives pay attention to some oddities in the behavior of the sick person:

inexplicable optimism;
increased excitability;
performing ritual actions;
nervous tics;
sudden changes in mood: the appearance of fears, insomnia, fussiness.

In some cases, the only sign of sluggish schizophrenia in men may be a special reaction to external stimuli. Among these are depressive, hysterical, hypochondriacal or delusional. A similar reaction occurs, for example, when a highly valuable idea or object is lost.

But inadequate reactions cannot be ruled out as a result of the loss of a relative who was indifferent to the patient during his lifetime. During such periods, the patient develops persistent long-term depression, low mood, melancholy, and thoughts about the meaninglessness of life. As a person deepens into a depressive state, he becomes prone to self-blame for the death of a relative and obsessive memories. At the same time, hallucinations of the imagination appear.

The hypochondriacal reaction to a traumatic event manifests itself in suspicion. Patients believe that others are gloating about his grief or failure and catch mocking glances.

In the active phase of the disease, prolonged attacks occur, which are accompanied by depression with impaired thinking. In old age, the clinical picture is combined with anxiety, hysterics, delusions of jealousy, and litigiousness.

Depending on the obsessive disorders in low-grade schizophrenia, the following types are distinguished:

with symptoms of obsession;
with phenomena of depersonalization;
hypochondriacal;
with hysterical attacks;
low-symptomatic.

Schizophrenia with obsessional symptoms

The clinical picture of the disease with symptoms of obsession is more often observed in anxious patients with a suspicious character. The harbingers of the disease are fears and persistent obsessions. For example, fear of heights, darkness, magic, people and other phobias. In the active period of the disease, phobias and obsessions play a leading role in diagnosis. Typically, this condition is long-term and characterized by incomplete remissions. The attacks occur against the background of a depressive disorder.

Sluggish neurosis-like schizophrenia, along with phobias, is complemented by anxiety. Sometimes patients experience attacks that resemble temporary insanity. Unlike ordinary neurosis, sluggish schizophrenia is accompanied by constant doubts of the patient about the correctness of already committed actions, ambivalence towards something (for example, love and hatred at the same time). An attack can last from several months to several years. Patients may exhibit the following symptoms:

obsessive urges;
lack of motivation;
contrasting thoughts;
fear of going crazy;
fear of injuring others or yourself;
fear of contracting deadly diseases.

Obsessive-compulsive disorder gradually increases over several years. Over time, phobias become less understandable and become absurd. At the same time, patients do not have the desire to fight them. The violations are accompanied by various rituals, a feeling of helplessness and the need for support from loved ones.

Schizophrenia with symptoms of depersonalization

A variant of sluggish schizophrenia, in which disturbances of self-awareness predominate. The disease occurs continuously or with attacks. The disorder usually begins during adolescence. More often this type of disease is observed in men. Characteristic features:

isolation;
shyness;
tendency to reflect;
impressionability;
coldness towards other people;
dissatisfaction with oneself;
somatic disorders: pain in the bridge of the nose and the back of the head, changes in gait.

During the progression of the disease, patients find their own actions unnatural. People often complain of an altered state. They believe that the former flexibility of the mind and imagination have disappeared. However, along with this, there is a feeling of isolation from others, insensitivity. The patients themselves complain that they have lost empathy, have lost the ability to feel satisfaction or dissatisfaction, and the world has become uninteresting and gray.

Patients cannot remember what they were like before and cease to be aware of their activities and actions. Everything is perceived as meaningless and alien, mechanical. Sometimes they do not understand gestures and speech addressed to them, they experience dependence on the people around them, they cease to perceive themselves as an individual, and they see the world through someone else’s eyes. Essentially, patients play certain roles.

After the age of twenty, during the period of stabilization of the disease, people feel an incompleteness of feelings. They are not captured by emotions, and there are no attachments to others. All relationships are created exclusively on a rational basis. It is difficult for a person to build relationships with people and get along in a new team.

After acute manifestations during the period of remission, patients become selfish, cold, completely immersed in their mental state. They ignore the needs of relatives and loved ones.

Sluggish schizophrenia with symptoms of hypochondria

This variant of schizophrenia manifests itself in patients prone to hysteria. Already from childhood, suspiciousness and uncertainty are noted in such people. Children often catch colds, they are sensitive to weather changes, suffer from migraines, indigestion, dizziness, and allergies. The clinical picture is blurred, since somatic diseases come to the fore.

As they grow older, patients complain of health, poor health, and severe incurable diseases, although upon examination no signs of pathology are found in them. Vegetative disorders often occur:

sweating;
dyspnea;
heart rhythm disturbance;
chills;
slight increase in temperature;
nausea;
sleep disorder

Against the background of autonomic disorders, sensory disturbances, movement disorders, bulimia, and pain in various organs appear. Patients are constantly under medical supervision, but schizophrenia is not always suspected. Characteristic mental symptoms of the disease are:

senesthesia - peculiar motor disturbances (for example, emptiness in the body or unexplained heaviness);
tearfulness;
pessimism;
irritability.

As the disease progresses, patients experience increased asthenia, a feeling of fatigue, and uncertainty. The acute period is manifested by fear of death. The person does not understand what is happening to him, calls an ambulance, and requires immediate examination and treatment. Theatricality prevails in the behavior of such people, with which they try to attract attention to themselves. Stable adherence to drug therapy is often observed.

Sluggish schizophrenia with manifestations of hysteria

As a rule, patients with this form of the disease are unbalanced and impulsive. The whims and hysterics that begin to appear in childhood come to the fore. Often patients are artistically gifted people. Hysteria in a child is often combined with such somatic manifestations as hyperkinesis, involuntary urination at night (enuresis).

The disease begins to have a noticeable effect by the age of 10 years. The child develops complexes, suspiciousness, demonstrative behavior, and expressiveness. Children wishful thinking and fantasize. They can deify someone with a hint of sexual desire (regardless of the patient’s age).

With age, such people become domestic tyrants, show intemperance, create violent scenes until they lose consciousness. Minor stress ends for them in a seething manifestation of emotions, dizziness, a feeling of lightheadedness, and impaired speech and writing.

During the period of exacerbation, the patient is prone to vagrancy, gambling, drug addiction and alcoholism. Sometimes patients experience pseudohallucinations, a craving for magical thinking, fatalism, a tendency to destruction, and the same type of behavior. The patient believes in his mission and divine influence on other people. Manifestations such as affectation, excessive frankness, and mannerisms are noteworthy. In old age, patients are more like eccentrics or slovenly extravagant ladies. Such people tend to emphasize their belonging to a “select community.”

Sluggish low-symptomatic schizophrenia

Signs of the disease often appear vigorously after 20 years of life. Patients experience the following symptoms:

decreased mental activity;
lack of initiative;
obsessive-compulsive disorders;
monosyllabic speech;
emotional poverty;
asthenia.