Sluggish form. Characteristic signs of low-grade schizophrenia

Sluggish schizophrenia is a disease that causes controversy among scientists and is not fully understood. However, what is certain is that it is not uncommon in the modern world. Therefore, it is important to know what kind of disease this is, what its symptoms and signs are, so that if schizophrenia is suspected in a person, this disease does not reach an advanced stage.

Sluggish, latent, or low-progressive schizophrenia. The main feature of this type of schizophrenia is the slow progression of the disease and, as a rule, the presence of only indirect clinical manifestations: neurosis-like, psycho-like, affective, hypochondriacal, etc., and shallow changes in a person’s personality. However, the ICD-10 list does not include the diagnosis of “sluggish schizophrenia”.

It is quite difficult to clearly determine the cause of schizophrenia. Currently, there are several versions of the sources of this disorder:

• hereditary predisposition;
• failure of the biochemical activity of neurotransmitters in the brain;
• negative impact of constant stress;
• the presence of certain social factors that negatively affect the education (formation of the psyche) of a person.

Stages, variants and forms of the disease

Note! In cases of indolent schizophrenia, the following stages of the disease are distinguished:

1. Latent (“debut”). Any deviations are not noticeable or barely noticeable. Among the characteristic signs of this stage, one can highlight the fact that a person is more often than usual in a state of depression; he can react too emotionally to stressful situations. The person also becomes more withdrawn and may develop various obsessions. At the same time, the patient still maintains contact with the outside world.
2. Active (manifest). The stage of progression of the disease, the signs gradually become more obvious. A sick person may develop causeless anxiety, fears, and manias. A person may also experience delusional states and develop psychopathy and paranoia. At this stage, patients can observe common similarities: unusual habits, constant reinsurance, decreased susceptibility to external stimuli. A sick person develops indifference to what is happening around him, and he may experience a clear decrease in his level of intelligence.
3. Stabilization. The patient does not show symptoms of the active stage, his behavior is absolutely normal and normal. This stage can last for a long time.

There are different options and forms of sluggish schizophrenia:

1. Asthenic variant of the course of the disease. Mental asthenia is characteristic without the presence of any real diseases in a person - objective reasons for its development. The patient experiences increased fatigue; he quickly gets tired of simple tasks that he previously performed with ease. A person tends to communicate with antisocial people.
2. Neurosis-like form of sluggish schizophrenia. Resembles obsessive-compulsive neurosis, but is characterized by the absence of personality conflict. It happens that a sick person performs a so-called “ritual” before performing any action.
3. Hysterical form of this disease. Characteristic of women, it consists of “selfish” and “cold” hysteria.
4. A form of “mild” schizophrenia with signs of depersonalization. Disorders in a person's self-perception are observed. Not a rare occurrence among teenagers.
5. Latent schizophrenia with manifestation of dysmorphomania. A person comes up with complexes for himself without any real reason (he may have absolutely no external flaws).
6. Hypochondriacal schizophrenia (read also what it is). A person is constantly worried that he is ill or may become ill with some physical disease.
7. Paranoid form. Reminds me of paranoid personality deviation.
8. A form of schizophrenia when affective disorders predominate. Subdepression with increased attention to self-analysis or hypomania are characteristic.
9. Variant with infertile disorders. The patient is characterized by negative symptoms.
10. Latent schizophrenia. No psychotic symptoms are observed. A latent schizophrenic experiences “mild pathological disorders.”

Symptoms and signs of the disease

The latent form of schizophrenia, as a type of schizophrenic disorder, involves the formation in a person of a so-called personality defect. This defect mainly consists of 7 symptoms:

1. Manifestation of indifference, “impoverishment” of emotions.
2. The desire to isolate yourself from the outside world.
3. Changing and narrowing the circle of one’s own interests.
4. Infantile states.
5. Disturbances in thinking.
6. Speech disorders.
7. Loss of skills of normal adaptation to the outside world.

These signs are also characteristic of sluggish schizophrenia; the only question is how long after the onset of a person’s illness they will appear in him.

Signs of low-grade schizophrenia in men

According to statistics, this type of schizophrenic disorder in males begins at an earlier age than in females. In men, the disease progresses more quickly; sick men require longer treatment. It has been established that the maximum number of sick people is between the ages of 19 and 28 years.

The following symptoms of the disease in men can be identified:

• a rapid decrease in the number of expressed emotions;
• impaired speech coherence;
• complete apathy;
• sometimes delusions and hallucinations.

It should also be noted that low-grade schizophrenia and alcoholism in men are closely related. Patients, feeling any mental changes, try to drown out the signs of the disease by drinking alcohol, often in large quantities, which leads to the development of alcohol dependence (which can also cause). And alcohol consumption leads to the progression of the disease - a vicious circle.

Symptoms of low-grade schizophrenia in women

Symptoms and signs in women are very similar to those in men, with some differences. The following distinctive signs of the disease in women can be identified:

• changes in appearance: sloppiness, unkemptness, bright and vulgar makeup;
• “Plyushkin syndrome”: a woman drags various rubbish home, instead of cleaning the house;
• sudden change of mood;
• manifestation of disease attacks.

Treatment, prognosis and prevention

Latent schizophrenia requires long-term and regular therapy. Treatment is carried out using small doses of new generation neuroleptics, psychostimulants, antidepressants, nootropic drugs, and tranquilizers.

Very important aspects in the treatment of schizophrenia, in addition to drug therapy, are psychotherapy and support of the patient by his loved ones. In order for a sick person to have a full life and to continue working, it is necessary to provide him with various special trainings aimed at rehabilitating the patient’s professional qualities.

Relatives of a sick person should closely monitor changes in his behavior. Only comprehensive treatment with medications, therapy with psychologists and psychotherapists, help from social workers and loved ones will allow a patient with latent schizophrenia to live a normal life.

If a person has reached the active (manifest) stage of the disease, hospitalization may be required. At the same time, relatives and the patient himself must understand its importance and not refuse the help of doctors in a hospital setting. However, the patient should not stay there for an artificially long time (for example, at the request of relatives). A person's prolonged stay in a hospital can negatively affect the course of the disease and, on the contrary, lead to its exacerbation.

Another important aspect in the treatment of this disorder is to involve the patient in creative activity, especially if he really wants it.

For example, there are different art therapies. Psychologists say that such procedures contribute to a favorable course of the disease. In addition, under no circumstances should the patient be locked at home, embarrassed to take him outside because of his slightly strange behavior. It is necessary to introduce the patient to cultural life. Give him the opportunity for self-realization.

Sluggish schizophrenia is a disease with a favorable prognosis. With proper treatment, the patient's seizures will occur very rarely. The person will remain an active member of society, he will be able to perform his labor functions.

To reduce the risk of further attacks of the disease, prevention is necessary. It consists in a correctly selected individual treatment regimen, which the patient must comply with. After all, a person often stops taking medications, which leads to relapses. Also very important in prevention is to reduce the frequency of conflicts in the family with a sick person to a minimum.

The question of schizophrenia and its latent form is discussed in his short video by psychotherapist Andrei Ermoshin. He briefly shares his opinion about the nature of this disease and methods of treating it.

It’s sad to realize, but sluggish schizophrenia is still an incurable disease. There are many reasons for its appearance. Therefore, a large number of people are under her gun. And if a person still gets sick, there is no need to despair . Complex treatment is required. This will help the patient live a full life.

Important! Be sure to check out this material! If after reading you still have any questions, we strongly recommend that you consult with a specialist by phone:

The location of our clinic in the park has a beneficial effect on the state of mind and promotes recovery:

Sluggish schizophrenia is one of the types of schizophrenic disorder in which symptoms develop gradually. The clinical picture of the pathology is blurred, which makes timely diagnosis and treatment difficult.

Diagnosis of low-grade schizophrenia

This type of schizophrenic disorder is diagnosed with a frequency of 0.1 – 0.4%. In the early stages, it is quite difficult to establish a diagnosis of sluggish schizophrenia, because schizophrenic psychoses and obvious productive signs of pathology are absent. The predominant symptoms may constitute a picture of one or another disease.

To confirm the diagnosis, the psychiatrist needs to conduct a thorough analysis of the patient’s personal data and determine whether cases of schizophrenia have occurred among blood relatives. It is important to pay attention to the presence of productive symptoms, such as:

• self-perception disorder;
• strange, inexplicable sensations in the body;
• visual, gustatory, auditory hallucinations;
• causeless anxiety;
• paranoia.

Symptoms of low-grade schizophrenia

The first signs of the disease often begin to appear already in adolescence, however, it is problematic to establish the time of manifestation of the pathology, since the clinical picture is blurred. The difference between sluggish schizophrenia and the classical form of the disorder is that the patient is completely absent of delusions and hallucinations. A person ceases to show activity and interest in surrounding events. Over time, his circle of interests narrows, his behavior becomes eccentric, his thinking and speech become demonstrative and pretentious.

As it progresses, the symptoms of low-grade schizophrenia become more severe. The patient begins to experience unreasonable fears, he is haunted by obsessive thoughts and depression. One’s actions are perceived as if from the outside, and they occasionally disturb:

• paranoia;
• various kinds of phobias;
• signs of hysteria;
• frequent mood changes;
• increased fatigue.

Symptoms increase gradually, sometimes over years. Therefore, the disorder is difficult to notice in time by others and by the patient himself, which is why the disease is dangerous.

Taking into account developing symptoms, the following stages of pathology are distinguished:

• Latent. It is characterized by mild symptoms and often goes unnoticed even by relatives. The patient refuses to communicate with others, leave home, or do important things. A depressive mood and nervous overexcitation often appear.
• Active. The signs of the disorder become pronounced, so even those around them see that something is wrong with the person. Hallucinations and delusions are absent in this form of schizophrenia, so even at the active stage, diagnosing the pathology is difficult. The patient is often bothered by panic attacks, unreasonable fears and worries.
• Weakened. The symptoms disappear, the condition returns to normal. With sluggish schizophrenia, the period of calm can last for decades.

If the pathology is diagnosed and treated in a timely manner, it will be possible to significantly slow down the progression of symptoms.

Signs of low-grade schizophrenia

Signs of low-grade schizophrenia differ depending on which type of mental disorder is progressing:

• Neurosis-like sluggish schizophrenia. Often manifested by fears and obsession. A person is afraid to be in crowded open places, he is afraid of contracting some terrible, incurable disease, he refuses to travel on a certain type of transport, etc. All these phobias are often accompanied by neuroses, obsessive thoughts and actions.
• Psychopathic-like schizophrenia. It often occurs with a phenomenon called depersonalization. As the disease progresses, the person begins to think that he has lost touch with his self, his past life and the events in it. Such patients develop insensitivity over time; no events can evoke emotions or a spiritual response in them. Often this type of schizophrenia is accompanied by hysteria, delusional ideas, and irreversible personality changes.

Sluggish schizophrenia in men

First of all, changes concern the behavior of men. He becomes cold, shows aloofness and hostility even towards people who love him. A person can become angry and rude for no apparent reason. Another sign by which sluggish schizophrenia in men is recognized is apathy and inactivity. It is worth being wary and taking a closer look at a man who suddenly left a previously beloved job and lost interest in a hobby that previously brought him pleasure and enjoyment.

As the pathology progresses, changes occur in the patient's appearance. He stops taking care of personal hygiene; he doesn’t care what clothes to wear. A person withdraws into himself, refuses to communicate with friends, and sometimes completely cuts off ties with the outside world, preferring to live in his inner world.

Sluggish schizophrenia in women

Sluggish schizophrenia in women often manifests itself at the age of 20–25 years, less often the first symptoms become noticeable after 30 years. The first sign may be obsession, unreasonable fears, meaningless rituals. For example, a woman will not enter an apartment until she counts to 15, or walks around a chair several times before sitting on it. At the same time, the patient is absolutely unaware of the absurdity of her actions and does not understand why those around her are looking at her so suspiciously.

Other characteristic signs of low-grade schizophrenia in women:

• psychopathic behavior;
• causeless aggression, irritability;
• loss of interest in current events, emotional coldness;
• mannerisms, inappropriate behavior;
• symptoms of depersonalization.

Sluggish schizophrenia in adolescents

Sluggish schizophrenia in adolescents manifests itself during the onset of puberty – 11–12 years. People around him notice increased emotionality, a tendency toward depression, and paranoid thoughts in the teenager. Other characteristic features:

• Change in speech style. A teenager cannot express thoughts correctly and logically; he often throws out meaningless phrases that are generally not appropriate in a particular conversation.
• Problems in studies. The disease prevents you from performing your duties efficiently, solving important tasks, moving towards goals, and overcoming obstacles.
• Problems concentrating. The teenager is constantly distracted, inhibited, and inadequate.
• Problems with socialization. The guy or girl avoids direct gaze, is reluctant to make contact, and cannot fully express their thoughts.

Sluggish schizophrenia in children

Sluggish schizophrenia in children can begin to manifest itself from the age of 7. The child begins to behave inappropriately, is afraid of everything, and talks to an invisible interlocutor. Other manifestations of the disease:

• Paranoia. It seems to the child that every person, even those close to him, wants to offend and humiliate him.
• Unreasonable fear. Children begin to panic fear even of ordinary things, and gradually their fears worsen.
• Insulation. Against the background of schizophrenic disorder, the child ceases to show interest in toys and entertainment. He refuses to communicate with other children and cannot build friendly relationships.
• Excessive moodiness. Children with indolent schizophrenia experience sudden and unreasonable mood changes.
• Speech problems. A progressive disease leads to problems with the ability to logically and consistently express one's thoughts. Such children often conduct conversations inappropriately, uttering phrases that have nothing to do with the topic being discussed.

Treatment of low-grade schizophrenia

Before starting treatment for sluggish schizophrenia, a psychiatrist at the Salvation clinic will observe the patient for several months, and only after that will make a final diagnosis. During this time, the doctor constantly talks with the patient’s relatives, asks about his behavior, analyzes the data and the dynamics of their development. In addition, the patient is given a referral for the following diagnostic studies:

• magnetic resonance and computed tomography;
• encephalography;
• duplex scanning;
• psychological tests;
• neurotesting.

Treatment for this type of schizophrenic disorder is complex. Specialists at the Salvation clinic use modern, safe, effective methods of therapy that help stop the progression of the pathology, maintain the patient’s ability to work and adapt to society.

The following methods are used for treatment at the Svoboda clinic:

• Drug therapy. Medications are prescribed: antipsychotics, tranquilizers, drugs that normalize the functioning of the nervous system. The treatment regimen is selected taking into account individual indications. The drugs used in our clinic do not cause side effects, do not contain harmful substances, and do not affect the psyche and the ability to think normally.
• Psychotherapy. Psychotherapy sessions help correct the patient’s behavioral reaction, increase his self-esteem, prevent isolation from family and society, and maintain his ability to work. The psychotherapist teaches the patient to control thoughts and emotions, behave correctly in society, not to despair and not to become depressed in the event of failures and defeats.
• Briefing. Throughout the entire treatment period, specialists conduct individual consultations with the patient. They advise how to behave in the family, society, what activity is best to choose in order to feel comfortable and safe.
• Working with family. Psychiatrists necessarily interact with the patient’s relatives. They tell relatives how to behave with a person suffering from sluggish schizophrenia, how to help and support him in difficult situations, and for which symptoms it is better to go to the hospital.

During periods of remission, communication with the doctor is not interrupted. The doctor regularly talks and advises the patient, and adjusts the list of medications as necessary. For schizophrenics, group classes are useful, during which people who find themselves in the same situation share problems and experiences in eliminating them. Communication takes place under the supervision of a psychiatrist, who also takes part in the conversation and gives useful advice and recommendations.

To prevent sluggish schizophrenia from progressing and the patient to feel normal, in addition to taking medications, it is necessary to adhere to the following rules:

• Maintain a daily routine. Go to bed, wake up, eat, walk and rest at the same time.
• To walk outside. Daily walks in the park are useful, you can ride a bicycle, rollerblades, or skateboard. It is better to walk when it is not too hot outside, otherwise overheating will worsen the condition.
• Eliminate the stress factor. It is better to avoid conflicts and stressful situations that cause nervous overload and a surge of negative emotions.
• Normalize nutrition. In case of mental disorders, it is better to exclude from the menu foods that stimulate the nervous system - coffee, strong tea, fatty, spicy, salty foods, alcohol.
• Connect light sports. Physical activity has a beneficial effect on the entire body. Daily morning exercises, swimming, yoga, and fitness promote the production of joy hormones, stimulate blood circulation, train muscles, and increase stress resistance.

At the Salvation clinic, highly qualified specialists successfully treat schizophrenic disorders. If a patient requires hospitalization, he is admitted to a hospital where a team of doctors monitors his condition. Treatment at the clinic is inexpensive, prices for services are open, they include the cost of all necessary procedures. Here you can really get real help and recover from a mental disorder.

The private clinic “Salvation” has been providing effective treatment for various psychiatric diseases and disorders for 19 years. Psychiatry is a complex field of medicine that requires maximum knowledge and skills from doctors. Therefore, all employees of our clinic are highly professional, qualified and experienced specialists.

When to ask for help?

Have you noticed that your relative (grandmother, grandfather, mother or father) does not remember basic things, forgets dates, names of objects, or does not even recognize people? This clearly indicates some kind of mental disorder or mental illness. Self-medication in this case is not effective and even dangerous. Tablets and medications taken independently, without a doctor’s prescription, will, at best, temporarily alleviate the patient’s condition and relieve symptoms. At worst, they will cause irreparable harm to human health and lead to irreversible consequences. Traditional treatment at home is also not able to bring the desired results; not a single folk remedy will help with mental illness. By resorting to them, you will only waste precious time, which is so important when a person has a mental disorder.

If your relative has poor memory, complete loss of memory, or other signs that clearly indicate a mental disorder or serious illness, do not hesitate, contact the private psychiatric clinic “Salvation”.

Why choose us?

The Salvation clinic successfully treats fears, phobias, stress, memory disorders, and psychopathy. We provide assistance with oncology, care for patients after a stroke, inpatient treatment for elderly and geriatric patients, and cancer treatment. We do not refuse the patient, even if he has the last stage of the disease.

Many government agencies are unwilling to take on patients over 50-60 years of age. We help everyone who applies and willingly provide treatment after 50-60-70 years. For this we have everything you need:

• pension;
• nursing home;
• bed-ridden hospice;
• professional caregivers;
• sanatorium.

Old age is not a reason to let the disease take its course! Complex therapy and rehabilitation gives every chance of restoring basic physical and mental functions in the vast majority of patients and significantly increases life expectancy.

Our specialists use modern diagnostic and treatment methods, the most effective and safe medications, and hypnosis. If necessary, a home visit is carried out, where doctors:

• an initial examination is carried out;
• the causes of mental disorder are determined;
• a preliminary diagnosis is made;
• an acute attack or hangover syndrome is relieved;
• in severe cases, it is possible to forcibly place the patient in a hospital - a closed rehabilitation center.

Treatment in our clinic is inexpensive. The first consultation is free. Prices for all services are completely open, they include the cost of all procedures in advance.

Relatives of patients often ask questions: “Tell me what a mental disorder is?”, “Advice how to help a person with a serious illness?”, “How long do they live with it and how to extend the allotted time?” You will receive a detailed consultation at the private clinic “Salvation”!

We provide real help and successfully treat any mental illness!

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Sluggish schizophrenia, or low progression schizophrenia, - a type of schizophrenia in which the disease progresses weakly, the productive symptoms characteristic of schizophrenic psychoses are absent, most often only indirect clinical manifestations are observed (neurosis-like, psychopath-like, affective, overvalued, hypochondriacal, etc.) and shallow personality changes. In the modern international classification of diseases (ICD-10) there is no such diagnosis.

Slightly progressive (sluggish) schizophrenia is used as a synonym for schizotypal disorder by many authors.

“Schizotypal personality disorder” in the Russian classification also corresponds to sluggish schizophrenia and coincides with it according to the diagnostic criteria accepted in Russian psychiatry.

The first descriptions of sluggish schizophrenia are often associated with the name of the Soviet psychiatrist A.V. Snezhnevsky. Its diagnostic boundaries, adopted by Snezhnevsky and his followers, were significantly expanded in comparison with the criteria for schizophrenia adopted in the West; the diagnosis of sluggish schizophrenia found application in the practice of repressive psychiatry in the USSR and was used more often than other clinical diagnoses to justify the insanity of dissidents.

The opinion has been repeatedly expressed that the diagnosis of sluggish schizophrenia was received or could be received not only by dissidents, but also by ordinary patients in the absence of schizophrenia and the presence only of neurotic disorders, depressive, anxiety or personality disorders.

The concept of sluggish schizophrenia became widespread only in the USSR and some other Eastern European countries. This concept has not been recognized by the international psychiatric community and the World Health Organization, and the use of diagnostic criteria for low-grade schizophrenia in relation to dissidents has been condemned internationally.

History of diagnosis: the concept of latent schizophrenia since Bleuler

There is an opinion that the authorship of the concept of sluggish schizophrenia is erroneously attributed to Snezhnevsky, since similar disorders were discussed under different names in the works of psychiatrists in different countries. It is also noted that it is in the works of Snezhnevsky and his colleagues that sluggish schizophrenia acts as an independent form and describes various options for its course.

The concept of “latent schizophrenia” was first used by Eugen Bleuler in 1911 (its criteria were not clearly defined by him):

These simple schizophrenics make up the majority of all “brains on one side” (reformers, philosophers, artists, degenerates, eccentrics). There is also latent schizophrenia, and I actually think these are the most common cases.

According to Bleuler, the diagnosis of latent schizophrenia can be made by studying the patient's condition retrospectively: when studying the past of persons with schizophrenia in whom the disease has become obvious, prodromes of the latent form can be detected.

E. Bleuler proposed considering a number of cases of psychasthenia, hysteria, and neurasthenia as manifestations of unrecognized schizophrenia. According to E. Bleuler, schizophrenia, which is most characterized by a peculiar splitting of the unity of the personality, more often occurs “in latent forms with mild symptoms than in obvious forms with complete symptomatology...”.

Subsequently, descriptions of relatively favorable forms corresponding to the concept of sluggish schizophrenia became widespread under various names in studies of national psychiatric schools in Europe, the USA, Japan, etc. The most famous of these names are “mild schizophrenia”, “microprocessual”, “micropsychotic”, “rudimentary” "", "sanatorium", "amortized", "abortive", "prephase of schizophrenia", "slow", "subclinical", "pre-schizophrenia", "non-regressive", "latent", "pseudo-neurotic schizophrenia", "schizophrenia with obsessive-compulsive disorders”, slowly developing schizophrenia with “creeping” progression.

In Soviet psychiatry, the description of similar forms of disorders has a long tradition: for example, A. Rosenstein and A. Kronfeld in 1932 proposed the term “mild schizophrenia”, which is similar in content; in this regard, we can mention the works of B. D. Friedman (1933), N. P. Brukhansky (1934), G. E. Sukhareva (1959), O. V. Kerbikov (1971), D. E. Melekhov (1963 ) and etc.

The author of the monograph “History of Schizophrenia,” French psychiatrist J. Garrabe, notes that in the period before World War II, the criteria for “schizophrenia without schizophrenic symptoms” underwent changes, being expanded to include a number of atypical, borderline conditions: in particular, Zilberg wrote about “outpatient schizophrenia " Often, studies dealt with so-called prepsychotic or pre-schizophrenic conditions - occurring in the period before the onset of psychosis, which, however, most often did not occur in this case.

The problem of “pseudoneurotic schizophrenia” was developed in American psychiatry throughout the 1950s and 60s, in particular by P. Hoch and P. Polatin, who proposed this term in 1949. According to J. Garrabe, in this case it would be more accurate to talk not about mental illness itself, which is characterized by processual (progressive) development, but about personality disorders (psychopathy), in particular about “borderline”, Russian. borderline personality disorder. The clinical and genetic study of schizophrenia spectrum disorders led to the interest of American researchers in the problem of pseudoneurotic schizophrenia in the next decade and a half (the concept of “borderline schizophrenia” by D. Rosenthal, S. Kety, P. Wender, 1968).

The broad interpretation of the concept of “schizophrenia” that prevailed in American psychiatry (the concept of “pseudo-neurotic schizophrenia”) was formed under the influence of the ideas of Bleuler, who considered schizophrenia mainly a psychological disorder - perhaps with a psychogenic basis - rather than a pathological state of the nervous system, and significantly expanded the boundaries of this concept in comparison with Emil Kraepelin. As a result, in the United States, the diagnosis of schizophrenia was extended to those patients who in Europe would have been diagnosed with depressive or manic psychosis, or even considered as suffering from a neurotic or personality disorder rather than a psychotic one. Patients were diagnosed with schizophrenia based on a wide range of neurotic symptoms, such as phobias or obsessions.

In 1972, a joint UK-US diagnostic project found that the diagnosis of schizophrenia was much more common in the US than in the UK. After this, the idea spread that standardized methods of diagnosis were needed. In the last quarter of the twentieth century, several diagnostic schemes were developed and continue to be widely used. These systems (particularly ICD-10 and DSM-IV) require clear evidence of current or past psychosis and that emotional symptoms are not predominant.

The concept of sluggish schizophrenia was proposed by Professor A.V. Snezhnevsky, according to some sources, in 1969. However, a report on latent schizophrenia (this concept was literally translated into English as “sluggish course”) was read by him back in 1966 in Madrid at the IV World Congress of Psychiatrists). Snezhnevsky's concept of sluggish schizophrenia was based on Bleuler's model of latent schizophrenia. Western psychiatrists considered this concept as unacceptable, since it led to an even greater expansion of the already expanded (including in English-speaking schools) diagnostic criteria for schizophrenia.

J. Garrabe notes that, according to the views of Snezhnevsky, expressed by him in 1966, latent (“torpid”, “flaccid”) schizophrenia means “chronic lesions that develop neither in the direction of deterioration nor in the direction of recovery.” Unlike Bleuler's latent schizophrenia, Snezhnevsky's concept of sluggish schizophrenia did not imply a mandatory development that would lead to the emergence of schizophrenic symptoms proper, but was limited only to latent (pseudo-neurotic or pseudo-psychopathic) manifestations.

In the chapter of the “Manual of Psychiatry” written by R. Ya. Nadzharov, A. B. Smulevich, which was published in 1983 under the editorship of Snezhnevsky, it is argued that, contrary to the traditional idea of ​​“sluggish schizophrenia” as an atypical variant of the disorder (i.e. . about deviation from the natural, more unfavorable development of the disease), low-progressive schizophrenia is not a protracted stage preceding major psychosis, but an independent variant of the endogenous process. In some cases, its characteristic signs determine the clinical picture throughout the entire course of the mental disorder and are subject to their own developmental patterns.

It is also worth noting that there were significant differences between the “mild schizophrenia” of A. Kronfeld, whose works were not republished during the 1960-80s, and the “sluggish schizophrenia” of A. V. Snezhnevsky. Thus, at the II All-Union Congress of Psychiatrists in 1936, Kronfeld made an explanation that the “mild schizophrenia” he identified is a variant of the overt schizophrenic process: this form always begins with a phase of acute psychosis and for many years retains this symptomatology, which, however, patients compensate so much that they remain socially safe. He noted the “exorbitant expansion” of his original concept of “mild schizophrenia” by Moscow authors, which led to its unjustified diagnosis in cases where we are talking about supposedly initial, rather than reliably residual symptoms and when these symptoms are not manifest. According to Kronfeld, the use of this concept in recent years has often been unfounded and due to fundamental clinicopathological errors.

Clinical manifestations and symptoms

As in the case of “ordinary” schizophrenia, the clinical criteria identified by proponents of the concept of low-grade schizophrenia are grouped into two main registers:

• pathologically productive disorders (“positive psychopathological symptoms”);
• negative disorders (manifestations of deficit, psychopathological defect).

In the clinical picture of sluggish schizophrenia, variants with a predominance of either productive disorders (obsessive-phobic, hysterical, depersonalization, etc.) or with a predominance of negative disorders (“sluggish simple schizophrenia”) are distinguished.

Accordingly, the following variants of sluggish schizophrenia are distinguished:

• with symptoms of obsession, or with obsessive-phobic disorders;
• with phenomena of depersonalization;
• hypochondriacal;
• with hysterical (hysteria-like) manifestations;
• poor (simple, sluggish) schizophrenia - with a predominance of negative disorders.

According to A. B. Smulevich, the following stages of development of low-progressive schizophrenia are distinguished:

1. Latent a stage that does not show clear signs of progression.
2. Active(with a continuous course, in the form of an attack or a series of attacks), or the period of full development of the disease.
3. Stabilization period with a reduction in productive disorders, personal changes coming to the fore, and signs of compensation emerging in the future.

Latent period. The clinical picture of this stage (and the so-called latent schizophrenia, which means a favorable form of sluggish schizophrenia, manifested only by symptoms of the latent period) is most often limited to a range of psychopathic and affective disorders, obsessions, and phenomena of reactive lability. Among psychopathic disorders, schizoid traits predominate, often combined with features reminiscent of hysterical, psychasthenic or paranoid personality disorder. Affective disorders in most cases manifest themselves as erased neurotic or somatized depression, prolonged hypomania with persistent and monotonous affect. In some cases, clinical manifestations of the initial (latent) stage of sluggish schizophrenia may be limited to special forms of response to external harm, often repeated in the form of a series of 2-3 or more psychogenic and somatogenic reactions (depressive, hysterical-depressive, depressive-hypochondriacal, less often - delusional or litigious).

According to A. B. Smulevich, mental disorders in the latent period are not very specific and can often manifest themselves only at the behavioral level; Children and adolescents are characterized by reactions of refusal (from taking exams, from leaving the house), avoidance (especially in cases of social phobia), and well-known states of youthful failure.

Active period and stabilization period. A distinctive feature of the development of most forms of low-progressive schizophrenia is considered to be a combination of attacks with a sluggish continuous course. Symptoms sluggish schizophrenia with obsessive-phobic disorders characterized by a wide range of anxiety-phobic manifestations and obsessions: panic attacks that are atypical in nature; rituals that take on the character of complex, fanciful habits, actions, mental operations (repetition of certain words, sounds, obsessive counting, etc.); fear of an external threat, accompanied by protective actions, “rituals” (fear of toxic substances, pathogenic bacteria, sharp objects, etc. entering the body); phobias of contrasting content, fear of madness, loss of control over oneself, fear of causing harm to oneself or others; constant obsessive doubts about the completeness of one’s actions, accompanied by rituals and double-checks (doubts about the purity of one’s body, clothes, surrounding objects); fear of heights, darkness, being alone, thunderstorms, fires, fear of blushing in public; and so on.

Sluggish schizophrenia with symptoms of depersonalization characterized primarily by the phenomena of alienation, extending to the sphere of the autopsyche (consciousness of changes in the inner world, mental impoverishment), and a decrease in vitality, initiative and activity. A detached perception of objective reality, a lack of a sense of appropriation and personification, and a feeling of loss of flexibility and sharpness of intellect may prevail. In cases of prolonged depression, the phenomena of painful anesthesia come to the fore: loss of emotional resonance, lack of subtle shades of feelings, the ability to feel pleasure and displeasure. As the disease progresses, a “feeling of incompleteness” may arise, extending both to the sphere of emotional life and to self-awareness in general; patients recognize themselves as changed, dull, primitive, and note that they have lost their former spiritual subtlety.

Clinical picture sluggish hypochondriacal schizophrenia consists of senestopathies and anxiety-phobic disorders of hypochondriacal content. There is non-delusional hypochondria (which is characterized by phobias and fears of hypochondriacal content: cardiophobia, cancerophobia, fears of some rare or unrecognized infection; obsessive observations and fixation on the slightest somatic sensations; constant visits to doctors; episodes of anxiety-vegetative disorders; hysterical, conversion symptoms ; senestopathies; overvalued desire to overcome the disease) and senestopathic schizophrenia (characterized by diffuse, varied, changeable, fanciful senestopathic sensations).

At sluggish schizophrenia with hysterical manifestations the symptoms take on grotesque, exaggerated forms: rude, stereotyped hysterical reactions, hypertrophied demonstrativeness, affectation and flirtatiousness with traits of mannerism, etc.; hysterical disorders appear in complex comorbid relationships with phobias, obsessive drives, vivid mastering ideas and senesto-hypochondriacal symptom complexes. Characteristic is the development of prolonged psychoses, the clinical picture of which is dominated by generalized hysterical disorders: confusion, hallucinations of the imagination with mystical visions and voices, motor agitation or stupor, convulsive hysterical paroxysms. At later stages of the disease (stabilization period), gross psychopathic disorders (deceit, adventurism, vagrancy) and negative disorders become more and more pronounced; Over the years, patients take on the appearance of lonely eccentrics, degraded but loudly dressed women who abuse cosmetics.

For sluggish simple schizophrenia characteristic phenomena of autochthonous asthenia with impaired self-awareness of activity; disorders of the anergic pole with extreme poverty, fragmentation and monotony of manifestations; depressive disorders related to the circle of negative affectivity (apathetic, asthenic depression with poor symptoms and an undramatic clinical picture); in phase disorders - increased mental and physical asthenia, depressed, gloomy mood, anhedonia, alienation phenomena, senesthesia and local senestopathy. Slowness, passivity, rigidity, mental fatigue, complaints of difficulty concentrating, etc. gradually increase.

According to a number of Russian authors (M. Ya. Tsutsulkovskaya, L. G. Pekunova, 1978; “Manual of Psychiatry” by A. S. Tiganov, A. V. Snezhnevsky, D. D. Orlovskaya, 1999), in many or even in most cases, patients with sluggish schizophrenia achieve compensation and full social and professional adaptation. According to Professor D. R. Luntz, the disease can theoretically be present even if it is not clinically demonstrable, and even in cases where there are no personality changes. R. A. Nadzharov and co-authors (chapter of the “Manual of Psychiatry” edited by G. V. Morozov, 1988) believed that this type of schizophrenia “due to the low severity of personality changes and the predominance of syndromes uncharacteristic for “major schizophrenia” presents significant difficulties for distinctions from psychopathy and neuroses.”

Sluggish schizophrenia and international classifications

In 1999, Russia switched to the ICD-10 classification of diseases, which has been used in WHO member countries since 1994. The concept of “sluggish schizophrenia” is absent in the ICD-10 classification, but it is mentioned in the Russian, adapted version, prepared by the Ministry of Health of the Russian Federation. In this version "forms that in the domestic version ICD-9 qualified as low-progressive or sluggish schizophrenia", classified under the heading “schizotypal disorder” (with the indication that their diagnosis requires additional signs). However, in the previous, also adapted version of the ICD-9 classification, used in the USSR since 1982, low-grade schizophrenia was included in the heading of another nosological unit - latent schizophrenia.

Many Russian authors use the terms “schizotypal disorder” and “sluggish schizophrenia” (“low-progressive schizophrenia”) as synonyms. On the other hand, there is also an opinion that schizotypal disorder represents only some of the clinical variants of sluggish schizophrenia, mainly pseudoneurotic (neurosis-like) schizophrenia and pseudopsychopathic schizophrenia. A. B. Smulevich writes about “the desirability of isolating sluggish schizophrenia from the polymorphic group of schizophrenia spectrum disorders, united by the concepts of “schizotypal disorder” or “schizotypal personality disorder”, considering it as an independent form of the pathological process. Some authors have stated the need to consider forms with neurosis-like (obsessive-compulsive) disorders within the framework of schizophrenia.

“Sluggish schizophrenia” in the Russian-Soviet classification is also identified with the diagnosis of “schizotypal personality disorder”, sometimes with borderline personality disorder or cyclothymia.

The opinion was also expressed that certain forms of sluggish schizophrenia in adolescents correspond to such concepts within the framework of the ICD-10 and DSM-III classifications as schizoid, impulsive, dissocial (asocial), histrionic (hysterical) personality disorders, residual schizophrenia, hypochondriacal syndrome ( hypochondria), social phobia, anorexia nervosa and bulimia, obsessive-compulsive disorder, depersonalization-derealization syndrome.

Practice of using diagnosis in the USSR

In 1966, the Soviet Union participated, among nine countries, in an international pilot study on schizophrenia organized by WHO. The study demonstrated that the diagnosis of “schizophrenia” was especially often made at the A. V. Snezhnevsky Center in Moscow; American researchers also adhered to an expanded diagnostic framework. 18% of patients diagnosed with schizophrenia were classified by the Moscow research center as having low-grade schizophrenia, a diagnosis that, however, was not registered in any of the other eight centers. This diagnosis was established in cases where computer processing reliably determined the presence of manic disorder, depressive psychosis, or, much more often, depressive neurosis in patients. The diagnosis of latent schizophrenia (a rubric not recommended by ICD-9 for widespread use) was also used by 4 of the 8 other study centers; it was exhibited by a total of less than 6% of the patients who took part in the study.

Sluggish schizophrenia was systematically diagnosed to ideological opponents of the political regime that existed in the USSR with the aim of their forced isolation from society. When diagnosing dissidents, they used, in particular, criteria such as originality, fear and suspicion, religiosity, depression, ambivalence, guilt, internal conflicts, disorganized behavior, insufficient adaptation to the social environment, change of interests, and reformism.

There are no exact statistics on the abuse of psychiatry for political purposes, however, according to various data, thousands of people became victims of political abuse of psychiatry in the USSR. In particular, according to R. van Voren, secretary general of the Global Initiative in Psychiatry, which deals with the problem of abuse in psychiatry and reforms of the mental health care system, in the Soviet Union about a third of political prisoners were placed in psychiatric hospitals. In addition to dissidents, the diagnosis of sluggish schizophrenia was also received, for example, by army evaders and tramps.

Individuals diagnosed with this condition were subject to severe discrimination and limited opportunities to participate in society. They were deprived of the right to drive a car, enter many higher educational institutions, and became “restricted from traveling abroad.” Before each holiday or state event, persons with this diagnosis were involuntarily hospitalized for the duration of the event in a psychiatric hospital. A person diagnosed with “sluggish schizophrenia” could easily get a “SO” (socially dangerous) stamp in his medical history - for example, when trying to resist during hospitalization or in the case when he became a participant in a family or street fight.

Patients who were diagnosed with “sluggish schizophrenia” by representatives of the Moscow school of psychiatry were not considered schizophrenics by psychiatrists in Western countries on the basis of the diagnostic criteria adopted there, soon officially enshrined in ICD-9. Supporters of other trends in Soviet psychiatry (especially representatives of the Kyiv and Leningrad schools) for a long time strongly opposed Snezhnevsky’s concept and the related concept of overdiagnosis of schizophrenia. Throughout the 1950s and 60s, representatives of the Leningrad school of psychiatry refused to recognize dissidents who were diagnosed with sluggish schizophrenia in Moscow as schizophrenics, and only by the late 1960s and early 1970s did Snezhnevsky’s concept finally prevail in Leningrad.

In the early 1970s, reports of the unnecessary hospitalization of political and religious dissidents in psychiatric hospitals reached the West. In 1989, a delegation of American psychiatrists visiting the USSR re-examined 27 suspected victims of abuse, whose names were provided to the delegation by various human rights organizations, the US Helsinki Commission and the State Department; clinical diagnosis was carried out in accordance with American (DSM-III-R) and international (ICD-10, draft) criteria. The delegation members also conducted surveys of patients' family members. The delegation concluded that in 17 of the 27 cases there was no clinical basis for exculpation; in 14 cases there were no signs of mental disorders. A review of all cases demonstrated a high incidence of schizophrenia diagnosis: 24 out of 27 cases. The report presented by the delegation noted that some of the symptoms included in the Soviet diagnostic criteria for mild (“sluggish”) schizophrenia and moderate (“paranoid”) schizophrenia are unacceptable for making this diagnosis according to American and international diagnostic criteria: in particular, Soviet psychiatrists attributed “ideas of reformism,” “increased self-esteem,” “increased self-esteem,” etc. to painful manifestations.

Apparently, this group of patients interviewed is a representative sample of the many hundreds of other political and religious dissidents declared insane in the USSR, mainly during the 1970s and 80s.

Famous examples of diagnosing dissidents

Viktor Nekipelov, accused under Article 190-1 of the Criminal Code of the RSFSR (“dissemination of deliberately false fabrications discrediting the Soviet political system”), was sent for examination to the Serbsky Institute with the following conclusion made by the expert commission of the city of Vladimir: “Excessive, excessive temper, arrogance... a tendency towards truth-seeking, reformism, as well as reactions from the opposition. Diagnosis: low-grade schizophrenia or psychopathy". He was declared mentally healthy at the Institute. Serbsky, served his time in a criminal camp.

Eliyahu Rips, accused under Article 65 of the Criminal Code of the Latvian SSR, corresponding to Art. 70 of the Criminal Code of the RSFSR (anti-Soviet agitation and propaganda), who attempted self-immolation in protest against the entry of Soviet troops into Czechoslovakia, was subjected to forced treatment in a “special type of mental hospital” with the same diagnosis.

Olga Iofe was accused under Article 70 of the Criminal Code of the RSFSR that she took an active part in the production of leaflets with anti-Soviet content, storage and distribution of documents with anti-Soviet content, seized from her during a search. Preliminary examination carried out by the Institute named after. Serbsky (Professor Morozov, Doctor of Medical Sciences D.R. Lunts, doctors Felinskaya, Martynenko), declared O. Iofe insane with a diagnosis of “sluggish schizophrenia, simple form.”

Many more examples can be given. They tried to make this diagnosis to V. Bukovsky, but the commission, which consisted mainly of opponents of the theory of sluggish schizophrenia, eventually declared him sane. This diagnosis was also made to Zhores Medvedev, Valeria Novodvorskaya, Vyacheslav Igrunov, who distributed the “Gulag Archipelago”, Leonid Plyushch, accused of anti-Soviet propaganda, Natalya Gorbanevskaya, charged under Article 190.1 of the Criminal Code of the RSFSR for the famous demonstration on Red Square against the entry of Soviet troops into Czechoslovakia - according to the conclusion of Professor Luntz, “the possibility of sluggish schizophrenia cannot be excluded”, “should be declared insane and placed for compulsory treatment in a special type of psychiatric hospital.”

Using the example of an examination carried out on April 6, 1970 in relation to Natalya Gorbanevskaya, the French historian of psychiatry J. Garrabe concludes about the low quality of forensic medical examinations carried out in relation to dissidents: the absence in the clinical description of changes in thinking, emotions and the ability to criticize, characteristic of schizophrenia; the absence of any expertly established connection between the action giving rise to the charge and the mental illness that could explain it; indication in the clinical description only of depressive symptoms that do not require hospitalization in a psychiatric hospital.

Condemnation of the practice of using diagnosis in the USSR by the international psychiatric community

In 1977, at a congress in Honolulu, the World Psychiatric Association adopted a declaration condemning the use of psychiatry for the purposes of political repression in the USSR. She also came to the conclusion that it was necessary to create a committee, later called the Committee of Inquiry. Review Committee) or more precisely, the WPA Committee to Investigate the Abuse of Psychiatry. WPA Committee to Review the Abuse of Psychiatry), which, according to its competence, must investigate any alleged cases of the use of psychiatry for political purposes. This committee is still active today.

Condemnation of the practice of using the diagnosis “sluggish schizophrenia” in the USSR led to the fact that in 1977, at the same congress, the World Psychiatric Association recommended that psychiatric associations in various countries adopt classifications of mental illnesses that are compatible with the international classification in order to be able to compare the concepts of different national schools. This recommendation was followed only by the American Psychiatric Association: in 1980 it adopted the DSM-III (Diagnostic and Statistical Manual of Mental Disorders), which excluded diseases without obvious psychiatric signs and recommended for what was previously called “latent”, “borderline”, “ "sluggish" or "simple" schizophrenia, make a diagnosis of a personality disorder, for example, schizotypal personality.

The All-Union Scientific Society of Neuropathologists and Psychiatrists of the USSR, refusing to acknowledge the facts of abuse, chose to leave the WPA in 1983, along with the psychiatric associations of other countries of the Soviet bloc. In 1989, at the IX Congress of the WPA in Athens, in connection with perestroika, it was again admitted to the World Psychiatric Association, pledging to rehabilitate the victims of “political psychiatry.” Victims of “political psychiatry” who were subjected to repression in the form of forced placement in psychiatric institutions and rehabilitated in accordance with the established procedure should be paid monetary compensation by the state. Thus, the facts of the use of psychiatry for political purposes were recognized.

According to data published by the International Society for Human Rights in the White Book of Russia, in the country as a whole, the diagnosis of low-grade schizophrenia resulted in the recognition of about two million people as mentally ill. They began to be gradually discharged from psychiatric hospitals and removed from psychiatric registration in psychoneurological dispensaries only in 1989 in order to achieve admission of the All-Union Scientific Society of Neuropathologists and Psychiatrists of the USSR to the World Psychiatric Association, which it was forced to leave at the VII Congress in 1983. In 1988-1989, at the request of Western psychiatrists, as one of the conditions for the admission of Soviet psychiatrists to the WPA, about two million people were removed from psychiatric registration.

Modern Russian psychiatry relies heavily on the works of A.V. Snezhnevsky: for example, in A.B. Smulevich’s book “Low-progressive schizophrenia and borderline states,” a number of neurotic, asthenic and psychopathic conditions are classified as low-progressive schizophrenia. J. Garrabe in the monograph “History of Schizophrenia” notes:

Harold Merskey, Bronislava Shafran, who devoted a review to “sluggish schizophrenia” in the British Journal of Psychiatry, find no less than 19 publications on this issue in the S. S. Korsakov Journal of Neuropathology and Psychiatry between 1980 and 1984, of which 13 were signed by Soviet authors, Moreover, these articles do not bring anything new in comparison with the report on this by A.V. Snezhnevsky. This loyalty of the Moscow school to a controversial concept at the very moment when it is attracting such criticism from the scientific community is surprising.

Overdiagnosis of schizophrenia also occurs in post-Soviet times. Thus, systematic studies show that the diagnosis of the entire group of affective pathology in modern Russian psychiatry is negligibly small and relates to schizophrenia in a factor of 1:100. This completely contradicts the data of foreign genetic and epidemiological studies, according to which the ratio of these diseases is 2:1. This situation is explained, in particular, by the fact that, despite the official introduction of ICD-10 in 1999, Russian doctors still continue to use the version of this manual adapted for Russia, which is similar to the version of ICD-9 adapted for the USSR. It is also noted that patients with severe and long-term panic disorder or obsessive-compulsive disorder are often unfoundedly diagnosed with sluggish schizophrenia and prescribed antipsychotic therapy.

Views and assessments

On the broad scope of diagnosis and prerequisites for its use for non-medical purposes

The opinion is often expressed that it was the broad diagnostic criteria for sluggish schizophrenia, promoted by Snezhnevsky and other representatives of the Moscow school, that led to the use of this diagnosis for repressive purposes. Western, as well as modern Russian psychiatrists and human rights activists note that the diagnostic criteria of the disease, which included erased, unexpressed symptoms, made it possible to diagnose it for anyone whose behavior and thinking went beyond social norms.

Canadian psychiatrist Harold Merskey and neurologist Bronislava Shafran in 1986, after analyzing a number of publications in the S.S. Korsakov Journal of Neurology and Psychiatry, came to the conclusion that “the concept of sluggish schizophrenia is obviously very flexible , is diverse and includes much more than our ideas about simple schizophrenia or a residual defective state. Many mental conditions that in other countries would most likely be diagnosed as depressive disorders, anxiety neuroses, hypochondria or personality disorders, according to Snezhnevsky’s theory, invariably fall under the concept of sluggish schizophrenia.”

Russian psychiatrist Nikolai Pukhovsky calls the concept of mild (sluggish, slow and imperceptible) schizophrenia mythologized and points out that the fascination of Russian psychiatrists with it coincided with a legal deficiency that allowed the state to use this diagnosis for the purposes of political repression. He notes the absurdity of such formulations as “the reason for the difficulty of recognizing schizophrenia with a slow, sluggish onset is the absence of any pronounced disturbances in mental activity in the initial period” And “outpatient treatment is also carried out for patients with a sluggish, slow and imperceptible type of schizophrenia, not accompanied by noticeable personality changes”, and indicates that the fascination with the theory of mild schizophrenia, as well as the idea of ​​the inferiority of the mentally ill and the supposedly inevitable outcome of mental illness into dementia, was associated with manifestations of overprotection, systematic disregard of the interests of patients and actual evasion of the idea of ​​service, the idea of ​​therapy; the psychiatrist, in fact, acted as an adherent of dubious esoteric knowledge.

The famous Ukrainian psychiatrist, human rights activist, executive secretary of the Association of Psychiatrists of Ukraine Semyon Gluzman notes that in the 1960s, the diversity of Soviet psychiatric schools and directions was replaced by the dictates of the school of Academician Snezhnevsky, which gradually became absolute: alternative diagnostics were persecuted. This factor - as well as the peculiarities of the legal field in the USSR (the absence of legal acts at the legislative level regulating the practice of compulsory treatment), as well as the “iron curtain” that separated Soviet psychiatrists from their Western colleagues and prevented regular scientific contacts - contributed to massive abuses in psychiatry , the frequent use in judicial and extrajudicial psychiatric practice of the diagnosis “sluggish schizophrenia” and its presentation to political dissidents.

In the “Manual on Psychiatry for Dissenters,” published in the “Chronicle of the Defense of Rights in the USSR” (New York, 1975, issue 13), V. Bukovsky and S. Gluzman express the opinion that the diagnosis of sluggish schizophrenia in mentally healthy people is socially adapted and prone to creative and professional growth, could determine the presence of such characterological features as isolation, a tendency to introspection, lack of communication, and inflexibility of beliefs; with objectively existing surveillance and wiretapping of telephone conversations, a dissident could be revealed to have “suspicion” and “delusions of persecution”. V. Bukovsky and S. Gluzman cite the words of an experienced expert, Professor Timofeev, who wrote that “dissent can be caused by a brain disease, when the pathological process develops very slowly, gently, and its other signs remain for the time being (sometimes until the commission of a criminal act) invisible”, who mentioned the difficulties of diagnosing “mild and erased forms of schizophrenia” and the debatability of their very existence.

Ukrainian forensic psychiatrist, Candidate of Medical Sciences Ada Korotenko points out that the school of A.V. Snezhnevsky and his colleagues, who developed a diagnostic system in the 1960s, including the concept of sluggish schizophrenia, was supported by F.V. Kondratiev, S.F. Semenov , Ya. P. Frumkin and others. Vague diagnostic criteria, according to A. I. Korotenko, made it possible to fit individual personal manifestations into the framework of the disease and recognize healthy people as mentally ill. Korotenko notes that the establishment of mental pathology in free-thinking and “dissident” citizens was facilitated by the lack of diagnostic standards and the USSR’s own classification of forms of schizophrenia: diagnostic approaches of the concept of sluggish schizophrenia and paranoid states with delusions of reformism were used only in the USSR and some Eastern European countries.

St. Petersburg psychiatrist Doctor of Medical Sciences Professor Yuri Nuller notes that the concept of the Snezhnevsky school allows, for example, to consider schizoid psychopathy or schizoidness as early, slowly developing stages of an inevitable progressive process, and not as personality traits of an individual, which do not necessarily have to develop along the way schizophrenic process. From here, according to Yu. L. Nuller, comes the extreme expansion of the diagnosis of sluggish schizophrenia and the harm that it brought. Y. L. Nuller adds that within the framework of the concept of sluggish schizophrenia, any deviation from the norm (according to the doctor’s assessment) can be considered schizophrenia, with all the ensuing consequences for the person being examined, which creates a wide opportunity for voluntary and involuntary abuse of psychiatry. However, neither A.V. Snezhnevsky nor his followers, according to Nuller, found the civil and scientific courage to reconsider their concept, which had clearly reached a dead end.

In the book “Sociodynamic Psychiatry,” Doctor of Medical Sciences, Professor T. P. Korolenko and Doctor of Psychological Sciences N. V. Dmitrieva note that the clinical description of sluggish schizophrenia according to Smulevich is extremely elusive and includes almost all possible changes in the mental state, as well as partially conditions that occur in a person without mental pathology: euphoria, hyperactivity, unreasonable optimism and irritability, explosiveness, sensitivity, inadequacy and emotional deficit, hysterical reactions with conversion and dissociative symptoms, infantility, obsessive-phobic states, stubbornness.

The President of the Independent Psychiatric Association, Yu. S. Savenko, wrote that the complete distortion of the phenomenological approach in conditions of total ideologization and politicization led to an unprecedented scale of overdiagnosis of schizophrenia. He noted that Snezhnevsky and his followers considered any processuality, that is, the progression of the disease, as a specific pattern of schizophrenia, and not a general psychopathological, general medical characteristic; hence the desire to diagnose schizophrenia in any syndromic picture and any type of course, although in reality the differential diagnosis of erased, outpatient forms of schizophrenia with other endogenous disorders requires careful individualization. Ultimately, this led to the inevitable attribution of many neurosis-like and paranoid states to schizophrenia, often even in the absence of procedurality. According to Yu. S. Savenko, the clear delineation of the diagnostic framework of Kronfeld’s “mild schizophrenia” turned out to be replaced in the 1960-80s by “a continuous continuum of quantitative differences from the healthy norm.” Yu. S. Savenko pointed out that the academic approach of Snezhnevsky and his followers is characterized by “refined sophistication, not suitable, even contraindicated, for widespread use, divorced from taking into account the social aspect: the possibilities of real practice, social compensation, the social consequences of such diagnostics.”

American psychiatrist Walter Reich (lecturer of psychiatry at Yale University, head of the program of medical and biological sciences at the Washington School of Psychiatry) noted that due to the nature of political life in the Soviet Union and the social stereotypes formed by this life, nonconformist behavior there really seemed strange and that in connection with the nature of Snezhnevsky’s diagnostic system, this oddity in some cases began to be perceived as schizophrenia. According to Reich, in many and perhaps most cases where such a diagnosis was made, not only the KGB and other responsible persons, but also the psychiatrists themselves actually believed that the dissidents were sick. Discussing during a personal meeting with Snezhnevsky in the early 1980s a program to study borderline states planned for the Scientific Center for Mental Health, Reich came to the conclusion that there is no significant difference between these borderline states and some “mild” forms of schizophrenia, especially low-grade schizophrenia. : It is possible that many or even most people whose behavioral characteristics meet Snezhnevsky’s criteria for this disorder do not actually suffer from it, since these behavioral manifestations should be considered within the framework of a neurotic disorder, character abnormalities, or simply qualified as normal behavior.

On the creation of the concept of low-grade schizophrenia

Different points of view have been expressed regarding the question of whether the concept of low-grade schizophrenia was created specifically to combat dissent.

Walter Reich noted that Snezhnevsky's concepts were formed under the influence of a number of his teachers and acquired their final form long before the placement of dissidents in psychiatric hospitals acquired any noticeable proportions; thus, these views arose independently of their supposed usefulness in diagnosing dissenters. However, it was precisely the errors contained in these theories that made them easy to apply to dissidents. The presence of these concepts, according to Reich, was only one of the reasons why dissidents in the USSR were diagnosed with mental illness, but a very important reason.

Vladimir Bukovsky, who was diagnosed with “sluggish schizophrenia” by Snezhnevsky in 1962, spoke as follows:

I don’t think that Snezhnevsky created his theory of sluggish schizophrenia specifically for the needs of the KGB, but it was unusually suitable for the needs of Khrushchev’s communism. According to the theory, this socially dangerous disease could develop extremely slowly, without manifesting itself or weakening the patient’s intelligence, and only Snezhnevsky himself or his students could determine it. Naturally, the KGB tried to ensure that Snezhnevsky’s students more often became experts on political affairs.

The French scientist J. Garrabe shares Bukovsky's opinion on this matter and comes to the conclusion that the repressive apparatus penetrated into a theoretical weak point, and it was not the Moscow school of psychiatry that deliberately committed scientific forgery in order to make it possible to use psychiatry for repression against dissidents. According to Garrabe, Snezhnevsky alone should not be held responsible for psychiatric abuses; Perhaps some of his students shared Snezhnevsky's views on sluggish schizophrenia quite sincerely, while other experts, disapproving of these views, may have been wary of criticizing them publicly. Nevertheless, Garrabe emphasizes that condemnation of the abuses of psychiatry that took place in the USSR should be based not only on ethical considerations, but also on scientific criticism of the concept of “sluggish schizophrenia.”

An article published in the Independent Psychiatric Journal on the occasion of the 100th anniversary of A.V. Snezhnevsky mentions the expanded diagnosis of schizophrenia (three times the international one) used for non-medical purposes. But the same article cites the opinion of Yu. I. Polishchuk, who worked for many years under the leadership of A.V. Snezhnevsky, who wrote that the basis for the abuse of psychiatry was created by the totalitarian regime, and not by the concept of sluggish schizophrenia, which served only as a convenient excuse for them. According to the editors, the extensive diagnosis of schizophrenia in different eras could acquire different meanings: in 1917-1935, concepts such as “mild schizophrenia” by L. M. Rosenstein and “schizophrenia without schizophrenia” by P. B. Gannushkin saved from execution, in In the 1960s and 70s, an overly broad diagnostic framework, on the contrary, served to discredit and suppress the human rights movement.

American psychiatrist Elena Lavretsky believes that the weakness of the democratic tradition in Russia, the totalitarian regime, repression and the “extermination” of the best psychiatrists between 1930 and 1950 paved the way for the abuse of psychiatry and the Soviet concept of schizophrenia.

On the other hand, according to R. van Voren, most experts are of the opinion that the psychiatrists who developed the concept of sluggish schizophrenia did this on the instructions of the party and the State Security Committee, understanding very well what they were doing, but at the same time believing that this concept logically explains a person's willingness to sacrifice well-being for an idea or belief that is so different from what most people believed or forced themselves to believe.

A similar opinion was expressed by the famous human rights activist Leonard Ternovsky: according to his assumption, the diagnosis “sluggish schizophrenia” was invented by the staff of the Serbsky Institute, Academician A.V. Snezhnevsky, G.V. Morozov and D.R. Lunts specifically for the needs of punitive psychiatry.

Western researchers of the political abuses of psychiatry in the USSR, political scientist P. Reddaway and psychiatrist S. Bloch, consider Snezhnevsky one of the key figures who led the use of psychiatry to suppress free thought in the Soviet Union, noting that Snezhnevsky introduced a new interpretation of the disease, which created the possibility of viewing ideological dissent as a symptom of a severe mental disorder.

Sluggish schizophrenia in art

• “Sluggish schizophrenia” is the title of an album of songs by Alexander Rosenbaum, released in December 1994.
• “It flows sluggishly, like the Moscow River, my dear has schizophrenia” - a line from the song “Steppen Wolf” (album “Mythology”) by the rock group “Crematorium”

Literature

• Snezhnevsky A.V. Schizophrenia and problems of general pathology. Bulletin of the USSR Academy of Medical Sciences, Medicine, 1969.
• Schizophrenia. Multidisciplinary research / Ed. A. V. Snezhnevsky, M., 1972.
• Endogenous mental illnesses. Edited by Tiganov A.S.
• Panteleeva G. P., Tsutsulkovskaya M. Ya., Belyaev B. S. Heboid schizophrenia. M., 1986.
• Bashina V. M. Early childhood schizophrenia, M., 1989.
• Lichko A. E. Schizophrenia in adolescents, L., 1989.
• Smulevich A. B. Low-progressive schizophrenia and borderline states, M., 1987.

– this is one of the varieties of schizophrenia, characterized by slow progression of the disease, the absence of schizophrenic and obvious productive symptoms of the disease. Clinical manifestations are quite vague, personality changes are superficial.

You can come across the term low-progressive schizophrenia or schizotypal disorder, which doctors also use to designate sluggish schizophrenia. In addition, the following definitions of this mental disorder are found: prephase, sanatorium, microprocessual, occult, non-psychotic, pseudoneurotic disease.

An important distinguishing feature of this type of schizophrenia is the lack of progression. This means that the patient does not degrade after some time, the symptoms of the disease do not intensify, and the personality does not transform. In addition, people with low-grade schizophrenia do not suffer from delusions and hallucinations; they have other neurotic disorders.

Symptoms of low-grade schizophrenia

It is quite difficult to determine the symptoms of this subtype of schizophrenia, which is due to the peculiarities of its course.

Sluggish disorder can occur as follows:

With the prevalence of symptoms of paranoia, with a predominance of disturbances in thinking and perception, with disruptions in motor skills of the limbs and facial expressions.

With signs of hysteria: with an obsessive desire to occupy a leading position in society, with a desire for admiration and surprise. This is expressed in vulgar, noisy behavior, frequent mood swings, unsteadiness of gait, increased trembling of the limbs and head in moments of excitement. Sometimes such patients experience hysterical attacks with sobbing, beating themselves, etc.

With signs of hypochondria, which is combined with increased anxiety, with a desire to analyze the natural processes taking place in the body. Often such patients have an obsession with their incurable disease, and they perceive the absence of any pathological symptoms as a signal of imminent death.

According to the type of asthenia with the prevalence of astheno-depressive syndrome, with increased fatigue, with frequent mood swings. Such patients are withdrawn, have difficulty making contact, and strive for solitude.

A type of obsessive-compulsive neurosis, when patients suffer from various obsessions, thoughts, and manias. Most often this manifests itself in various phobias, causeless anxiety, and regularly repeated actions.

However, no matter what the type of disease, a person must always have one or more defects characteristic of sluggish schizophrenia.

They are characterized by the following symptoms:

Pseudopsychopathization. It is expressed in the fact that a person is simply replete with diverse and, in his opinion, extremely important ideas. He is always in high spirits, charged emotionally. The patient shows an active interest in the people around him, tries to prove his point of view to them so that they help him put his ideas into practice. The disease in this case manifests itself in the fact that all ideas seem valuable only to their bearer. In addition, the result of his activity does not lead to anything, it is zero.

Verschreuben. In this case, the patient becomes detached from reality, he forgets past life experiences, and exhibits pathological behavior. This is expressed in strange behavior, in stupid actions. A person does not realize the absurdity of his worldview; he is surprised if he finds out that he is considered wonderful. In the house of such a person there are a lot of old things, unnecessary rubbish, his home is unkempt, and his appearance is unkempt. Patients often completely ignore personal hygiene. Speech disturbances are observed, which is expressed in the most detailed description of absolutely unimportant details. The phrases are quite lengthy and do not make sense. Often such patients adhere to a certain idea and devote all their strength to realizing it, for example, counting the letters in great works. However, despite the strange behavior, such people are capable of work and study.

Defect in energy potential reduction. The range of interests of such people is narrowed, contacts are limited. The patient tries to avoid any vigorous activity and refuses to work. He does not strive for knowledge or creative development; he is often absolutely passive and indifferent to everything. She feels as comfortable as possible at home and does not want to leave it.

Stages of low-grade schizophrenia

The disease occurs in several stages:

Debut or latent stage, which may go unnoticed even by close people. Its symptoms are mild and blurred. The patient experiences prolonged hypomania, somatized depression, and persistent affects. This stage occurs during puberty. Teenagers may refuse to take an exam, stop leaving the house, and avoid communicating with other people.

manifest or active period when clinical symptoms of the disease increase. It is at this time that certain oddities begin to be noticed in a person, however, relatives may not seek help. Relatives do not perceive the eccentric behavior and statements of a schizophrenic as signs of illness, since there are no hallucinations and delusions. At this time, the patient himself suffers from panic attacks and experiences fears. In order to overcome them, such people often resort to rituals and double-checks (cleanliness of clothes, their own body, etc.).

Stabilization. The patient behaves absolutely normally, all the symptoms that manifested themselves at the manifestation stage calm down. Stabilization may continue for quite a long time.

Treatment of low-grade schizophrenia

When a patient is diagnosed with schizophrenia, he needs psychiatric treatment. First of all, it involves taking medications. It is worth remembering, no matter what remedy the doctor prescribes, you must take it without skipping. Only strict adherence to the treatment regimen can have a positive effect.

Therapy with traditional antipsychotics. Such drugs are aimed at blocking dopamine receptors. High-potency traditional antipsychotics are characterized by stronger connections with dopamine receptors and less strong connections with muscarinic and adrenergic receptors. Low-potency neuroleptics are used less frequently, as they have a weak affinity for dopamine receptors and a slightly greater affinity for histamine, adrenergic, and muscarinic receptors. The choice of one or another drug depends on the required method of administration; the patient’s condition and the severity of possible side effects are also assessed. It is worth noting that they can be quite serious, such as: muscle rigidity and dystonia, dullness of consciousness, etc. Such drugs include: Chlorpromazine, Thioridazine, Molindone, Thiotixene, Haloperidol, Fluphenazine Decanoate, Haloperidol Decanoate and others.

Second generation neuroleptics. These drugs can affect the functioning of not only dopamine but also serotonin receptors. Their advantage over first-generation drugs is that they have less pronounced side effects. The question of greater effectiveness in relation to the symptoms of the disease remains controversial. These drugs include: Risperidone, Clozapine, Olanzapine, Quetiapine, Aripiprazole, Ziprasidone. While taking these medications, it is necessary to carefully monitor the patient's body weight, as well as monitor for possible signs of developing type 2.

In addition to receiving drug therapy, patients no less need social support. Psychosocial skills training and programs aimed at professional rehabilitation of patients must be used. This allows people with indolent schizophrenia to continue working, take care of themselves, and feel comfortable in society.

Close people should never turn a blind eye to violations in the behavior of a loved one. Only an integrated approach to treatment, together with a psychotherapist, a psychologist, and social workers, will allow the patient to live a full life.

During the manifest period, hospitalization of the patient may be required. You should not refuse it if the doctor insists on it. However, it is also impossible to artificially prolong the patient’s stay in the hospital. Staying in the hospital for too long can make your symptoms worse. People living with family avoid exacerbations longer.

It is important to involve patients in creativity. For this purpose, there are special art therapies that are popular among practicing psychologists. People with indolent schizophrenia are advised to visit cultural places accompanied by a healthy person; they should not hide him from society or be embarrassed by somewhat unusual behavior. All doctors are unanimous in the opinion that if a patient shows a craving for creativity, he should be supported in this and not interfere with self-realization.

Forecast and prevention of attacks of low-grade schizophrenia

The disease has a favorable prognosis. With an integrated approach to treatment, attacks will be extremely rare. Such patients will remain active members of society and will be able to fully perform work duties.

To reduce the risk of relapse of the disease, you must adhere to the treatment regimen prescribed by the doctor. Often it is the independent withdrawal of drugs that leads to an increase in attacks. In addition, it is important to avoid conflicts in the family and strive to protect the sick person as much as possible from possible complications.

Education: In 2005, she completed an internship at the First Moscow State Medical University named after I.M. Sechenov and received a diploma in the specialty “Neurology”. In 2009, she completed her postgraduate studies in the specialty “Nervous Diseases”.

Sluggish schizophrenia is a disease in which the patient exhibits unusual behavior and emotional reactions that are inappropriate to current events. However, in order to make a diagnosis of schizophrenia, there are no productive symptoms. In the modern international classification of diseases there is no such diagnosis; instead, schizotypal personality disorder is used. The diagnosis of a sluggish form of schizophrenia was first described in the USSR and was often used for political purposes.

Causes of low-grade schizophrenia and risk group

The causes of the disorder are not yet fully understood. Researchers suggest that the occurrence of the disease is influenced by a complex of factors: genetic predisposition, personal characteristics, social situation, and the presence of traumatic situations.

There is evidence that schizotypal personality disorder is more common in people whose loved ones have schizophrenia.

It can be difficult to distinguish and recognize low-grade schizophrenia because the clinical manifestations are similar to many other mental disorders. The disease begins slowly and develops over several years, which is why loved ones may not notice disturbances in a person’s behavior for a long time.

Stages and forms of the disease

The disease goes through stages:

1. Latent, hidden stage or debut. The period when the first signs and symptoms of low-grade schizophrenia appear. Most often this occurs in teenagers. The symptoms are not very pronounced, so loved ones may not notice changes in the person’s character. Often manifests itself as hypomania and somatized depression.
2. Active or manifest stage. Gradually, symptoms of the disease begin to appear. Fears and panic attacks arise. This is the period when the disease develops. It can occur continuously or be characterized by attacks of increasing symptoms.
3. State stabilization stage. At this stage, symptoms weaken or disappear completely, and the patient returns to usual forms of behavior.

The disease is divided into 2 types: psychopathic-like and neurosis-like schizophrenia.

The psychopathic type of disorder is characterized by signs of depersonalization. Patients think that they are unable to control their own actions. Patients demonstrate hysterical, insensitive behavior. They are often embittered and distant, losing emotional connections with loved ones. People can have strange hobbies. There is often a tendency to bad habits, such as abuse of alcoholic beverages and psychoactive substances.

The neurosis-like form occurs with predominant symptoms of fear, obsessive thoughts and actions. A person develops various phobias, including social phobia and hypochondriasis. People begin to demonstrate compulsive actions and rituals that help them relieve anxiety. This form of disorder differs from neuroses in that changes in behavior are not caused by a traumatic situation, and the symptoms increase gradually.

Symptoms and signs of low-grade schizophrenia

To make a diagnosis, symptoms must have been present for at least 2 years. People with the disorder are characterized by isolation and a desire to distance themselves from loved ones, inappropriate emotional reactions, eccentric appearance, non-compliance with generally accepted cultural norms, the presence of paranoid thoughts, signs of depersonalization and derealization, delusional ideas, unusual speech, demonstrative behavior, obsessive thoughts of a sexual and aggressive nature. Sometimes hallucinations may occur.

Among the signs of sluggish schizophrenia in men are emotional coldness and detachment. Often this reaction does not correspond to the event that caused it. For example, people may not react in any way to the loss of a loved one. Obsessions and phobias are also more common among male patients with schizotypal personality disorder.

Wearing bright and unusual clothes, using makeup that is too provocative for everyday life is a sign that is more typical for low-grade schizophrenia in women.

Treatment and prognosis of low-grade schizophrenia

Treatment is carried out by a psychiatrist and includes the use of medications, including psychotropic drugs. The goal is to achieve long-term remission. Tranquilizers, antipsychotics, and antidepressants are used in therapy.

It is best to combine taking pills with psychotherapy. For schizotypal personality disorder, both individual and group psychotherapy are effective. Working with a psychologist helps the patient adapt to society.

Before starting drug treatment for sluggish neurosis-like schizophrenia, you should make sure that the patient’s symptoms are not caused by neurosis that occurred after suffering mental trauma. In some cases, it is necessary to consult a neurologist and other doctors to exclude the possibility that behavioral patterns are caused by organic reasons.

If you follow the doctor's recommendations correctly, there is a greater chance of stabilizing your condition. Compared with schizophrenia, patients with schizotypal disorder have a more favorable prognosis for treatment. In rare cases, the disorder develops into schizophrenia. With proper therapy, it is possible to achieve the disappearance of symptoms, but pronounced changes in the patient’s personality remain; activity in society is restored fully or partially.