Sluggish form. Characteristic signs of sluggish schizophrenia

Sluggish schizophrenia is a disease that causes controversy among scientists and is not fully understood. However, it is reliably known that it is not rare in the modern world. Therefore, it is important to know what this disease is, what its symptoms and signs are, so that if schizophrenia is suspected in a person, this disease will not be brought to an advanced stage.

Sluggish, latent, or low progression schizophrenia. The main feature of this variety of schizophrenia is the slow progress 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;
• the negative impact of constant stress;
• the presence of certain social factors that adversely affect the upbringing (formation of the psyche) of a person.

Stages, variants and forms of the disease

Note! With a disease of sluggish schizophrenia, the following stages of the course of the disease are distinguished:

1. Latent ("debut"). Any deviations are not noticeable or hardly noticeable. Of the signs characteristic of this stage, it can be distinguished that a person is more often than usual in a state of depression, he may overreact emotionally to ongoing stressful situations. Also, a person becomes more withdrawn, he may have various obsessions.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 pronounced. A sick person may develop unreasonable anxiety, fears, manias. Also, a person may experience delusional states, he may develop psychopathy and paranoia. At this stage, patients can observe common similar features: unusual habits, constant reinsurance, decreased susceptibility to external stimuli. A sick person develops indifference to what is happening around, he may experience a clear decrease in the 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 continue for a long time.

There are different variants and forms of sluggish schizophrenia:

1. Asthenic variant of the course of the disease. Mental asthenia is characteristic without a person having any real diseases - objective reasons for its development. The patient has increased fatigue, he quickly gets tired of simple things that he previously performed with ease. A person tends to communicate with asocial people.
2. Neurosis-like form of sluggish schizophrenia. It resembles obsessive-compulsive disorder, but is characterized by the absence of personality conflict. It happens that a sick person performs the so-called "ritual" before performing any action.
3. The hysterical form of this disease. Characteristic for women, consists in "selfish" and "cold" hysteria.
4. A form of "mild" schizophrenia with signs of depersonalization. Disorders in self-perception of the person are observed. Not uncommon among teenagers.
5. Latent schizophrenia with manifestation of dysmorphomania. A person invents complexes for himself without any real reason for that (he may have absolutely no external flaws).
6. Hypochondriacal schizophrenia (read also what it is). A person is constantly worried that he is sick or may get sick with some kind of somatic disease.
7. paranoid form. Reminds me of a paranoid personality disorder.
8. A form of schizophrenia when affective disorders predominate. Characterized by subdepression with increased attention to introspection or hypomania.
9. Variant with unproductive disorders. The patient has negative symptoms.
10. latent schizophrenia. Psychotic symptoms are not observed. The latent schizophrenic experiences "mild pathological disorders."

Symptoms and signs of the disease

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

1. Manifestation of indifference, "impoverishment" of emotions.
2. Desire to protect yourself from the outside world.
3. Changing and narrowing the circle of one's own interests.
4. infantile states.
5. Breakdowns 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 manifest themselves in him.

Signs of sluggish schizophrenia in men

According to statistics, this type of schizophrenic disorder in males begins at an earlier age than in women. In men, there is a faster progression of the disease, sick men require longer treatment. It has been established that the maximum number of sick people falls on the age of 19-28 years.

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

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

It should also be noted that sluggish 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 the use of alcohol leads to the progression of the disease - a vicious circle.

Symptoms of sluggish schizophrenia in women

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

• changes in appearance: slovenliness, unkemptness, bright and vulgar make-up;
• "Plyushkin's syndrome": a woman drags various rubbish home, instead of cleaning the house;
• sudden change of mood;
• manifestation of the disease.

Treatment, prognosis and prevention

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

Very important aspects in the treatment of schizophrenia, in addition to drug therapy, are psychotherapy and support of the patient by his relatives and friends. In order for the life of a sick person to be full and he could continue to work, it is necessary to conduct various special trainings for him, focused on the rehabilitation of the patient's professional qualities.

Relatives of a sick person should carefully monitor changes in his behavior. Only complex treatment with drugs, therapy with psychologists and psychotherapists, the help of social workers and relatives will allow a patient with latent schizophrenia to live a normal life.

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

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

For example, there are different art therapies. Psychologists say that such procedures contribute to the favorable course of the disease. In addition, the patient in no case should be locked at home, embarrassed to take him out into the street because of a little strange behavior. It is necessary to attach the patient to cultural life. Give him the opportunity to self-actualize.

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

To reduce the risk of manifestation of the next attacks of the disease, prevention is necessary. It consists in a properly selected individual treatment regimen, which the patient must comply with. After all, often a person quits 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 a short video by psychotherapist Andrey Ermoshin. He briefly shares his opinion about the nature of this disease and how to treat it.

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

Important! Be sure to check out this article! 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 a type of schizophrenic disorder in which symptoms develop gradually. The clinical picture of the pathology is blurred, which complicates timely diagnosis and treatment.

Diagnosis of sluggish schizophrenia

This type of schizophrenic disorder is diagnosed with a frequency of 0.1 - 0.4%. In the early stages, it is rather difficult to establish a diagnosis of sluggish schizophrenia, because there are no schizophrenic psychoses and obvious productive signs of pathology. The predominant symptomatology can make up a picture of both one and the other disease.

To confirm the diagnosis, the psychiatrist needs to conduct a thorough analysis of the patient's personal data, to determine whether there have been cases of schizophrenia 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 sluggish schizophrenia

The first signs of the disease often begin to appear already in adolescence, but it is problematic to establish the time of manifestation of the pathology, since the clinical picture is blurred. The difference between sluggish schizophrenia and a disorder of the classical form is that the patient has no delusions and hallucinations. A person ceases to show activity and interest in surrounding events. Over time, the circle of his interests narrows, his behavior becomes eccentric, thinking and speech are demonstrative, pretentious.

As the progression progresses, the symptoms of indolent schizophrenia worsen. The patient begins to experience unreasonable fears, he is haunted by obsessive thoughts, depression. Their actions are perceived as if from the outside, they occasionally disturb:

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

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

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

• Latent. It is characterized by mild symptoms, often goes unnoticed even for relatives. The patient refuses to communicate with others, to leave the house, to do important things. Often there is a depressive mood, nervous overexcitation.
• Active. The signs of the disorder become pronounced, so even those around them see that something is wrong with the person. There are no hallucinations and delusions in this form of schizophrenia, therefore, even at the active stage, the diagnosis of pathology is difficult. The patient is often disturbed by panic attacks, unreasonable fears and worries.
• Weakened. Symptoms disappear, the condition returns to normal. With sluggish schizophrenia, the calm period 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 sluggish schizophrenia

Signs of indolent schizophrenia differ depending on which variant of the mental disorder is progressing:

• Neurosis-like sluggish schizophrenia. Often manifested by fear and obsession. A person is afraid to be in crowded open places, he is afraid of contracting some terrible, incurable disease, refuses to travel by a certain type of transport, etc. All these phobias are often accompanied by neuroses, obsessive thoughts and actions.
• psychopathic schizophrenia. Often occurs with such a phenomenon as depersonalization. As the sick person progresses, he begins to think that he has lost touch with his "I", a past life and events in it. In such patients, insensitivity develops over time, no events can cause them emotions, a spiritual response. Often this type of schizophrenia is accompanied by hysteria, delusional ideas, irreversible personality changes.

Sluggish schizophrenia in men

First of all, the changes relate to the behavior of men. He becomes cold, shows aloofness and hostility even to 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, inactivity. It is worth being alert and taking a closer look at a man who suddenly left his previously beloved job, lost interest in a hobby that previously brought him pleasure and enjoyment.

As the pathology progresses, changes in the appearance of the patient occur. He ceases to follow personal hygiene, he does not care what clothes to wear. A person withdraws into himself, refuses to communicate with friends, 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 has counted to 15, or she will walk around a chair several times before sitting on it. At the same time, the patient is absolutely unaware of the absurdity of her actions, does not understand why others are looking at her so suspiciously.

Other characteristic signs of sluggish schizophrenia in women:

• psychopathic behavior;
• causeless aggression, irritability;
• the disappearance of interest in ongoing events, emotional coldness;
• mannerism, inappropriate behavior;
• depersonalization symptoms.

Sluggish schizophrenia in adolescents

Sluggish schizophrenia in adolescents manifests itself during the onset of puberty - 11 - 12 years. People around notice a teenager's increased emotionality, a tendency to depression, paranoid thoughts. Other characteristic features:

• Change in the manner of speech. A teenager cannot express his thoughts correctly and logically, often he throws meaningless phrases that are not at all appropriate in a particular conversation.
• Problems in study. The disease prevents you from fulfilling your duties qualitatively, solving important tasks, moving towards goals, and overcoming obstacles.
• Problems in concentration. The teenager is constantly distracted, inhibited, inadequate.
• Problems with socialization. A guy or a girl avoids a direct look, reluctantly makes contact, 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, talks with an invisible interlocutor. Other manifestations of the disease:

• Paranoia. It seems to the child that every person, even a close one, wants to offend and humiliate him.
• Unreasonable fear. Children begin to be afraid of even ordinary things in a panic, gradually the fears are aggravated.
• Insulation. Against the background of a schizophrenic disorder, the child ceases to show interest in toys and entertainment. He refuses to communicate with other children, cannot build friendly relations.
• Excessive capriciousness. In children with sluggish schizophrenia, mood changes abruptly and for no reason.
• Problems with speech. A progressive disease leads to problems with the ability to logically and consistently express one's thoughts. Such children often lead the conversation inadequately, giving out phrases that have nothing to do with the topic under discussion.

Treatment of sluggish 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 he establish the final diagnosis. At 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 such diagnostic studies:

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

The treatment of this type of schizophrenic disorder is prescribed complex. Specialists of the Salvation clinic use modern, safe, effective methods of therapy that help stop the progression of the pathology, maintain the patient's working capacity and adaptation in society.

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

• Medical therapy. Medications are prescribed: neuroleptics, 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, do not affect the psyche and the ability to think normally.
• Psychotherapy. Psychotherapy sessions help to correct the patient's behavioral response, increase his self-esteem, prevent isolation from the family and society, and maintain working capacity. The psychotherapist teaches the patient to control thoughts and emotions, to behave correctly in society, not to despair and not to become depressed in case of failures and defeats.
• Briefing. Throughout the entire period of treatment, specialists conduct individual consultations with the patient. They advise how to behave in the family, society, what activity is better to choose in order to feel comfortable and safe.
• Family work. Psychiatrists necessarily interact with the relatives of the patient. They tell their relatives how to behave with a person suffering from sluggish schizophrenia, how to help and support him in difficult situations, 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 consults the patient, adjusts the list of medications as necessary. For schizophrenics, group sessions are useful, during which people who find themselves in the same situation share problems and experience in eliminating them. Communication takes place under the supervision of a psychiatrist, who also takes part in the conversation, gives useful advice and recommendations.

In order for sluggish schizophrenia not to progress and the patient to feel normal, in addition to taking medication, it is necessary to adhere to the following rules:

• Follow the daily routine. Go to bed, wake up, eat, walk and rest at the same time.
• To walk outside. Useful daily walks in the park, you can ride a bike, rollerblade, skateboard. It is better to take a walk when it is not too hot outside, otherwise overheating leads to a deterioration in 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 food. For mental disorders, it is better to exclude foods that stimulate the nervous system from the menu - coffee, strong tea, fatty, spicy, salty foods, alcohol.
• Connect light sport. Physical activity has a beneficial effect on the entire body. Daily morning exercises, swimming, yoga, fitness contribute to the production of hormones of joy, stimulate blood circulation, train muscles, and increase stress resistance.

In the clinic "Salvation" highly qualified specialists successfully treat schizophrenic disorders. If the patient requires hospitalization, he is placed in a hospital, where the condition is monitored by a team of doctors. 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 Salvation Private Clinic has been providing effective treatment of various psychiatric diseases and disorders for 19 years. Psychiatry is a complex area of ​​medicine that requires doctors to have maximum knowledge and skills. 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 elementary things, forgets dates, names of objects or even does not recognize people? This clearly indicates some kind of mental disorder or mental illness. Self-medication in this case is not effective and even dangerous. Pills and medications taken on their own, without a doctor's prescription, 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. Alternative 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 lose precious time, which is so important when a person has a mental disorder.

If your relative has a bad memory, complete loss of memory, other signs that clearly indicate a mental disorder or a serious illness, do not hesitate, contact the Salvation Private Psychiatric Clinic.

Why choose us?

The clinic "Salvation" successfully treats fears, phobias, stress, memory disorders, psychopathy. We provide oncology care, stroke care, inpatient care for the elderly, elderly 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 the age of 50-60. 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 hospice;
• professional nurses;
• sanatorium.

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

Our specialists use in their work modern methods of diagnostics and treatment, the most effective and safe medicines, hypnosis. If necessary, home visits are carried out, where doctors:

• an initial inspection is carried out;
• the causes of mental disorder are clarified;
• a preliminary diagnosis is made;
• an acute attack or a hangover syndrome is removed;
• in severe cases, it is possible to force the patient to be placed in a hospital - a closed-type rehabilitation center.

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

Relatives of patients often ask questions: “Tell me what a mental disorder is?”, “Advise 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 in the private clinic "Salvation"!

We provide real help and successfully treat any mental illness!

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

Low-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 adopted 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 was used in the practice of repressive psychiatry in the USSR and more often than other clinical diagnoses was used 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 of only 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, the use of diagnostic criteria for low-grade schizophrenia in relation to dissidents is internationally condemned.

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 other names in the works of psychiatrists from various countries. It is also noted that it is in the works of Snezhnevsky and his collaborators that sluggish schizophrenia acts as an independent form and various variants of its course are described.

The concept of "latent schizophrenia" was first used by Eigen 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 that 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 apparent, prodromes of the latent form can be detected.

As manifestations of unrecognized schizophrenia, E. Bleuler proposed to consider a number of cases of psychasthenia, hysteria, and neurasthenia. According to E. Bleuler, schizophrenia, which is most characteristic of a kind of splitting of the unity of the personality, often occurs "in latent forms with mild symptoms than in explicit forms, with complete symptomatology ...".

Subsequently, descriptions of relatively favorable forms corresponding to the concept of indolent 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”, “pre-phase schizophrenia”, “slow-flowing”, “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” that is similar in content; in this regard, we can also mention the works of B. D. Fridman (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 the Second World War, 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 the so-called prepsychotic, or pre-schizophrenic states - arising in the period before the development of psychosis, which, however, most often did not occur in this case.

The problem of "pseudo-neurotic schizophrenia" was developed in American psychiatry during 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 correct to speak not about the actual mental illness, which is characterized by procedural (progressive) development, but about personality disorders (psychopathies), in particular, about “borderline”, Rus. borderline personality disorder. 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" D. Rosenthal, S. Kety, P. Wender, 1968).

The broad interpretation of the concept of "schizophrenia", which 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 - and not a pathological condition 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 extended to those patients who in Europe would have received a diagnosis of depressive or manic psychosis, or even be considered as suffering not from a psychotic, but from a neurotic disorder or personality disorder. 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 showed that the diagnosis of schizophrenia was much more common in the US than in the UK. After this, the idea that standardized methods of diagnosis were needed became widespread. In the last quarter of the 20th century, several diagnostic schemes were developed and continue to be widely used. These systems (in particular, ICD-10 and DSM-IV) require clear evidence of psychosis in the present or past, and that emotional symptoms are not leading.

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 translated into English literally as “sluggish course”) was read by him back in 1966 in Madrid at the IV World Congress of Psychiatrists). The concept of Snezhnevsky's sluggish schizophrenia was based on Bleuler's model of latent schizophrenia. Western psychiatrists regarded 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", "sluggish") schizophrenia means "chronic lesions that do not develop either towards deterioration or towards recovery." Unlike Bleuler's latent schizophrenia, the concept of Snezhnevsky's sluggish schizophrenia did not imply a mandatory development that would lead to the appearance of proper schizophrenic symptoms, but was limited only to latent (pseudo-neurotic or pseudo-psychopathic) manifestations.

In the chapter of the Guide to 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 ​​\u200b\u200b"sluggish schizophrenia" as an atypical variant of the disorder (i.e. . about the deviation from the regular, 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 a number of cases, its characteristic signs determine the clinical picture throughout the course of a mental disorder and are subject to their own patterns of development.

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. So, at the II All-Union Congress of Psychiatrists in 1936, Kronfeld made an explanation that the "mild schizophrenia" he singled out is a variant of an obvious 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 it is supposedly initial, and not reliably residual symptoms and when this symptomatology is not manifest. According to Kronfeld, the use of this concept in recent times has often been unjustified and is due to fundamental clinical and pathological errors.

Clinical manifestations and symptoms

As in the case of "common" schizophrenia, the clinical criteria identified by proponents of the concept of indolent schizophrenia are grouped into two main registers:

• pathologically productive violations ("positive psychopathological symptoms");
• negative violations (manifestations of deficiency, psychopathological defect).

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

Accordingly, the following variants of sluggish schizophrenia are distinguished:

• with the phenomena of obsession, or with obsessive-phobic disorders;
• with the phenomena of depersonalization;
• hypochondriacal;
• with hysterical (hysterio-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 reveal distinct signs of progression.
2. Active(with a continuous course, in the form of an attack or a series of attacks), or a period of complete development of the disease.
3. Stabilization period with a reduction in productive disorders, personality changes that come to the fore and signs of compensation that form in the future.

Latent period. The clinic 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 reactive lability phenomena. Among psychopathic disorders, schizoid features predominate, often combined with signs resembling hysterical, psychasthenic or paranoid personality disorder. Affective disorders in most cases are manifested by blurred neurotic or somatized depressions, prolonged hypomania with persistent and monotonous affect. In some cases, the 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, hystero-depressive, depressive-hypochondriacal, less often - delusional or lingering).

According to A. B. Smulevich, mental disorders in the latent period are of little specificity 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 the combination of seizures with a sluggish continuous course. Symptoms indolent schizophrenia with obsessive-phobic disorders characterized by a wide range of anxiety-phobic manifestations and obsessions: panic attacks, which are atypical in nature; rituals that acquire the character of complex, pretentious habits, actions, mental operations (repetition of certain words, sounds, obsessive counting, etc.); fear of an external threat, accompanied by protective actions, “rituals” (fear of penetration into the body of toxic substances, pathogenic bacteria, sharp objects, etc.); phobias of contrasting content, fear of insanity, loss of control over oneself, fear of causing damage to oneself or others; constant obsessive doubts about the completeness, completeness of one's actions, accompanied by rituals and rechecks (doubts about the cleanliness 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 depersonalization phenomena it is characterized primarily by the phenomena of alienation, extending to the sphere of autopsychics (consciousness of the change 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, a feeling of loss of flexibility and sharpness of the intellect may prevail. In cases of prolonged depression, the phenomena of painful anesthesia come to the fore: the loss of emotional resonance, the absence of subtle shades of feelings, the ability to feel pleasure and displeasure. With the development of the disease, a “feeling of incompleteness” may arise, extending both to the sphere of emotional life and to self-consciousness in general; patients realize themselves as changed, stupefied, primitive, note that they have lost their former spiritual subtlety.

Clinical picture sluggish hypochondriacal schizophrenia consists of senestopathies and anxiety-phobic disorders of hypochondriacal content. Non-delusional hypochondria is distinguished (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; an overvalued desire to overcome the disease) and senestopathic schizophrenia (characterized by diffuse diverse, changeable, pretentious senestopathic sensations).

At sluggish schizophrenia with hysterical manifestations symptoms take on grotesque, exaggerated forms: rude, stereotyped hysterical reactions, hypertrophied demonstrativeness, affectation and coquettishness with features of mannerisms, etc.; hysterical disorders appear in complex comorbid relationships with phobias, obsessive drives, vivid mastery ideas and senesto-hypochondriac symptom complexes. The development of protracted psychoses is characteristic, in the clinic of which generalized hysterical disorders predominate: clouding of consciousness, hallucinations of the imagination with mystical visions and voices, motor excitation or stupor, convulsive hysterical paroxysms. At the later stages of the disease (the period of stabilization), gross psychopathic disorders (deceit, adventurism, vagrancy) and negative disorders are becoming more and more pronounced; over the years, patients take on the appearance of lonely eccentrics, downtrodden, but loudly dressed, abusing cosmetics women.

For indolent simple schizophrenia the phenomena of autochthonous asthenia with violations of self-awareness of activity are characteristic; 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 non-dramatic clinical picture); with phase disorders - increased mental and physical asthenia, depressed, gloomy mood, anhedonia, alienation phenomena, senesthesias and local senestopathies. 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; A. S. Tiganov’s Guide to Psychiatry, A. V. Snezhnevsky, D. D. Orlovskaya, 1999), in many or even in most cases, patients with sluggish schizophrenia achieve compensation, complete social and professional adaptation. According to Prof. D. R. Lunts, the disease may theoretically be present even if it is clinically unprovable, and even in cases where there are no personality changes. R. A. Nadzharov and co-authors (chapter of the Guide to 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 of “great schizophrenia” presents significant difficulties for separation 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 of it, prepared by the Ministry of Health of the Russian Federation. In this variant "forms that in the domestic version ICD-9 qualified as low-progressive or sluggish schizophrenia", are classified under the heading "schizotypal disorder" (with an indication that their diagnosis requires additional features). However, in the previous, also adapted version of the ICD-9 classification, used in the USSR since 1982, sluggish 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, it has also been argued that schizotypal disorder represents only some of the clinical variants of indolent schizophrenia, mainly pseudoneurotic (neurosis-like) schizophrenia and pseudopsychopathic schizophrenia. A. B. Smulevich writes about “the desirability of separating sluggish schizophrenia from the polymorphic group of schizophrenic 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.

"Slow schizophrenia" in the Russian-Soviet classification is also identified with a 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 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.

The practice of applying the diagnosis in the USSR

In 1966, the Soviet Union took part, among nine states, in an international pilot study on schizophrenia organized by WHO. The study showed that the diagnosis of "schizophrenia" was especially often exhibited in the center of A. V. Snezhnevsky in Moscow; American researchers also adhered to the extended diagnostic framework. 18% of patients diagnosed with schizophrenia were classified by the Moscow Research Center as patients with sluggish 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 the ICD-9 for general use) was also used by 4 of 8 other research centers; it was exhibited by a total of only less than 6% of the patients who took part in the study.

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

Accurate statistics on the abuse of psychiatry for political purposes do not exist, however, according to various sources, 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 the reform of the mental health care system, in the Soviet Union about a third of political prisoners were placed in psychiatric hospitals. The diagnosis of sluggish schizophrenia was received, in addition to dissidents, also, for example, vagrants who evaded the army.

Persons who received this diagnosis were subjected to severe discrimination and were limited in their opportunities to participate in society. They were deprived of the right to drive a car, to enter many higher educational institutions, and became "travel restrictions". Before each holiday or state event, people with this diagnosis were involuntarily hospitalized for the duration of the event in a psychiatric hospital. A person with a diagnosis of "sluggish schizophrenia" could easily get "SO" (socially dangerous) in his medical history - for example, when trying to resist during hospitalization or when he became a member of a family or street fight.

Patients who were diagnosed with "sluggish schizophrenia" by representatives of the Moscow School of Psychiatry were not considered as 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 the concept of Snezhnevsky and the overdiagnosis of schizophrenia associated with this concept. Throughout the 1950s and 1960s, representatives of the Leningrad school of psychiatry refused to recognize as schizophrenics dissidents who were diagnosed with sluggish schizophrenia in Moscow, and only by the late 1960s and early 1970s did Snezhnevsky's concept finally prevail in Leningrad.

In the early 1970s, reports of unjustified hospitalizations of political and religious dissenters in psychiatric hospitals reached the West. In 1989, a delegation of American psychiatrists visiting the USSR conducted a re-examination of 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 diagnostics was carried out in accordance with American (DSM-III-R) and international (ICD-10, draft) criteria. Members of the delegation also interviewed family members of patients. The Delegation concluded that in 17 of the 27 cases there was no clinical reason for exculpation; in 14 cases there were no signs of mental disorders. A review of all cases showed 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 were 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 interviewed patients represents a representative sample of many hundreds of other political and religious dissidents who were declared insane in the USSR, mainly during the 1970s and 80s.

Notable examples of diagnosing dissidents

Viktor Nekipelov, charged under article 190-1 of the Criminal Code of the RSFSR (“dissemination of deliberately false fabrications discrediting the Soviet state system”), was sent for examination to the Serbsky Institute with the following conclusion issued by the expert commission of the city of Vladimir: “Excessive, excessive irascibility, arrogance ... a tendency to seek the truth, reformism, as well as the reactions of the opposition. Diagnosis: sluggish schizophrenia or psychopathy ". He was recognized as mentally healthy at the Institute. Serbsky, served 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 to set himself on fire in protest against the entry of Soviet troops into Czechoslovakia, was subjected to compulsory treatment in a "psychiatric hospital of a special type" 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 anti-Soviet leaflets, storage and distribution of anti-Soviet documents confiscated from her during a search. Preliminary examination carried out by the Institute. Serbsky (Professor Morozov, Doctor of Medical Sciences D. R. Lunts, doctors Felinskaya, Martynenko), recognized O. Iofe as insane with a diagnosis of "sluggish schizophrenia, a simple form."

Many more examples could be cited. They tried to make this diagnosis to V. Bukovsky, but the commission, which consisted mainly of opponents of the theory of sluggish schizophrenia, eventually recognized him as sane. Also, this diagnosis was made to Zhores Medvedev, Valeria Novodvorskaya, Vyacheslav Igrunov, who distributed the Gulag Archipelago, Leonid Plyushch, accused of anti-Soviet propaganda, Natalya Gorbanevskaya, accused 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 Lunts, "the possibility of sluggish schizophrenia is not ruled out", "should be declared insane and placed on compulsory treatment in a psychiatric hospital of a special type."

On the example of an examination conducted on April 6, 1970 in relation to Natalia Gorbanevskaya, the French historian of psychiatry J. Garrabe concludes that the quality of forensic medical examinations carried out in relation to dissidents is low: the absence in the clinical description of changes in thinking, emotions and the ability to criticize, characteristic of schizophrenia; the absence of any connection established by the examination between the act that led to the accusation and a mental illness that could explain it; an indication in the clinical description of only depressive symptoms that do not require hospitalization in a psychiatric hospital.

Condemnation of the practice of applying 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 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 (eng. Review Committee) or, more specifically, the WPA Psychiatric Abuse Investigation Committee. WPA Committee to Review the abuse of Psychiatry), which, according to its competence, should investigate any alleged use of psychiatry for political purposes. This committee is still active today.

The condemnation of the practice of using the diagnosis of "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 diseases 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 ruled out diseases without obvious psychiatric signs and recommended for what used to be called “latent”, “borderline”, “ sluggish" or "simple" schizophrenia, to be diagnosed with a personality disorder, such as schizotypal personality.

The All-Union Scientific Society of Neurologists and Psychiatrists of the USSR, refusing to acknowledge the facts of abuse, chose to leave the WPA in 1983, along with 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, undertaking 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 the prescribed manner 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 Paper of Russia, in the whole country, the result of the diagnosis of sluggish schizophrenia was the recognition of about two million people as mentally ill. They began to be gradually discharged from psychiatric hospitals and removed from psychiatric records in neuropsychiatric dispensaries only in 1989 in order to achieve admission of the All-Union Scientific Society of Neurologists 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 the psychiatric register.

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

Harold Merskey, Bronislava Shafran, who devoted a review in the British Journal of Psychiatry to "sluggish schizophrenia", found at least 19 publications on this subject in the Korsakov Journal of Neurology and Psychiatry between 1980 and 1984, of which 13 were signed by Soviet authors, moreover, these articles do not introduce anything new in comparison with the report on this by A. V. Snezhnevsky. This fidelity of the Moscow school to a controversial concept at the very moment when it provokes such criticism from the scientific community is amazing.

Overdiagnosis of schizophrenia also takes place in the post-Soviet period. Thus, systematic studies show that the diagnosis of the entire group of affective pathology in modern Russian psychiatry is negligible and refers to schizophrenia in a multiplicity 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 the ICD-10 in 1999, Russian doctors still continue to use the version of this manual adapted for Russia, similar to the version of the ICD-9 adapted for the USSR. It is also noted that patients with severe and prolonged course of panic disorder or obsessive-compulsive disorder are often unreasonably diagnosed with sluggish schizophrenia and neuroleptic therapy is prescribed.

Views and assessments

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

It is often argued 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 for 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 Journal of Neurology and Psychiatry named after S. S. Korsakov, concluded that “the concept of sluggish schizophrenia is obviously very loose , varied and includes much more than our ideas of simple schizophrenia or residual defective condition. Many mental conditions that in other countries would most likely be diagnosed as depressive disorders, anxiety disorders, 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 imperceptibly flowing) schizophrenia mythologized and points out that Russian psychiatrists' fascination with it coincided with a legal deficit that allowed the state to use this diagnosis for political repression. He notes the absurdity of such formulations as “the reason for the difficulty in recognizing schizophrenia with a slow, sluggish onset is the absence of any pronounced mental disorders in the initial period” And “outpatient treatment is also carried out for patients with a sluggish, slowly and imperceptibly ongoing variety of schizophrenia, not accompanied by noticeable personality changes”, and points out 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 in dementia, was associated with manifestations of overprotection, a systematic disregard for the interests of patients and an actual evasion of the idea of ​​service, the idea of ​​therapy; the psychiatrist at the same time, in fact, acted as an adherent of dubious esoteric knowledge.

The well-known 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 legislative acts 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 of the diagnosis "sluggish schizophrenia" in judicial and extrajudicial psychiatric practice and its exposure to political dissidents.

In "Psychiatry Handbook for Dissidents", 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 skills, inflexibility of convictions; with objectively existing surveillance and wiretapping, a dissident could reveal “suspicion”, “delusions of persecution”. V. Bukovsky and S. Gluzman cite the words of an experienced expert, Professor Timofeev, who wrote that “dissent may be due to a disease of the brain, when the pathological process develops very slowly, gently, and its other signs for the time being (sometimes before the commission of a criminal act) remain imperceptible", 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 staff, 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 personality manifestations into the framework of the disease and recognize healthy people as mentally ill. Korotenko notes that the absence of diagnostic standards and the operation in the USSR of its own classification of forms of schizophrenia contributed to the establishment of mental pathology among free-thinking and "dissident" citizens: diagnostic approaches to 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. Yu. L. Nuller adds that within the framework of the concept of sluggish schizophrenia, any deviation from the norm (according to the doctor) can be considered as schizophrenia, with all the ensuing consequences for the subject, 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 Ts. P. Korolenko and Doctor of Psychological Sciences N. V. Dmitrieva note that the clinical description of Smulevich’s sluggish schizophrenia 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, infantilism, obsessive-phobic states, stubbornness.

President of the Independent Psychiatric Association Yu. S. Savenko wrote that the complete distortion of the phenomenological approach in the conditions of total ideologization and politicization led to an unprecedented scale of overdiagnosis of schizophrenia. He noted that Snezhnevsky and his followers considered any process, 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 to schizophrenia of many neurosis-like and paranoid states, often even in the absence of processuality. According to Yu. S. Savenko, in the 1960s and 80s, the clear definition of the diagnostic framework of Kronfeld's "mild schizophrenia" was replaced 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 refinement, unsuitable, even contraindicated for widespread use, divorced from taking into account the social aspect: the possibilities of real practice, social compensation, and the social consequences of such a diagnosis.”

The American psychiatrist Walter Reich (lecturer of psychiatry at Yale University, head of the medical and biological sciences program 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. In Reich's opinion, in many and perhaps most of the cases when such a diagnosis was made, not only the KGB and other responsible persons, but also the psychiatrists themselves really believed that the dissidents were sick. During a personal meeting with Snezhnevsky in the early 1980s, Reich concluded that there was no significant difference between these borderline conditions and some "mild" forms of schizophrenia, especially sluggish schizophrenia. : it is possible that many or even most people whose behavioral characteristics meet the criteria for this disorder identified by Snezhnevsky do not actually suffer from it, since these behavioral manifestations should be considered within the framework of a neurotic disorder, anomalies of character, or simply qualify as normal behavior.

On the creation of the concept of sluggish schizophrenia

Differing views have been expressed on the question of whether the concept of sluggish 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 out of touch with their supposed usefulness in diagnosing dissidents. However, it is precisely the errors contained in these theories that have made it easy to apply them to dissidents. The presence of these concepts, according to Reich, was only one of the reasons due to which dissidents in the USSR were diagnosed with mental illness, but the reason is very important.

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

I do not 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 in any way and without weakening the intellect of the patient, and only Snezhnevsky himself or his students could determine it. Naturally, the KGB tried to ensure that Snezhnevsky's students more often fell into the number of experts in political affairs.

The French scientist J. Garrabe shares Bukovsky's opinion on this matter and comes to the conclusion that the repressive apparatus penetrated a theoretically weak spot, and not the Moscow school of psychiatry deliberately committed a scientific forgery in order to make it possible to use psychiatry to repress dissidents. According to Garrabe, Snezhnevsky alone should not be held responsible for the abuse of psychiatry; it is possible that some of his students shared Snezhnevsky's views on sluggish schizophrenia quite sincerely, while other experts, while disapproving of these views, may have been wary of criticizing them publicly. Nevertheless, Garrabe emphasizes that the 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 for the 100th anniversary of A.V. Snezhnevsky mentions an extensive 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 the concept of sluggish schizophrenia, which served only as a convenient excuse for them. According to the editors, the broad diagnosis of schizophrenia in different eras could acquire different meanings: in 1917-1935, such concepts as “mild schizophrenia” by L. M. Rosenstein and “schizophrenia without schizophrenia” by P. B. Gannushkin saved from execution, in In the 1960s and 70s, the overly broad diagnostic framework, on the contrary, served to discredit and suppress the human rights movement.

The American psychiatrist Elena Lavretsky believes that the weakness of the democratic tradition in Russia, the totalitarian regime, the repression and "extermination" of the best psychiatrists in the period from 1930 to 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 so different from what most people believed or forced themselves to believe.

A similar opinion was expressed by the well-known human rights activist Leonard Ternovsky: according to his assumption, the diagnosis of "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 political abuse 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 opportunity to consider ideological dissent as 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, in a sweet schizophrenia” - a line from the song “Steppe Wolf” (album “Mythology”) of the rock group “Krematorium”

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 illness. Edited by Tiganov A.S.
• Panteleeva G. P., Tsutsulkovskaya M. Ya., Belyaev B. S. Geboid 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 conditions, M., 1987.

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

You can come across the term low-progressive schizophrenia or schizotypal disorder, which doctors also refer to indolent schizophrenia. In addition, there are the following definitions of this mental disorder: prephase, sanatorium, microprocessing, occult, non-psychotic, pseudo-neurotic 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, the personality does not transform. In addition, people with sluggish schizophrenia do not suffer from delusions and hallucinations, they have other neurotic disorders.

Symptoms of sluggish schizophrenia

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

A sluggish disorder can proceed as follows:

With the prevalence of symptoms of paranoia, with a predominance of impaired thinking and perception, with malfunctions of the 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, unsteady gait, increased trembling of the limbs and head during moments of excitement. Sometimes such patients have hysterical fits with sobs, beatings, etc.

With signs of hypochondria, which is combined with increased anxiety, with the 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 closed, hardly make contact, seek solitude.

According to the type of obsessional neurosis, when patients suffer from various obsessions, thoughts, manias. Most often, this manifests itself in various phobias, in causeless anxiety, in regularly repeated actions.

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

They are characterized by the following symptoms:

Pseudopsychopathization. It is expressed in the fact that a person is simply replete with diverse and extremely important, in his opinion, 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 is manifested in the fact that all ideas seem valuable only to their carrier. In addition, the result of his activity does not lead to anything, it is zero.

Verschreuben. In this case, the patient is separated from reality, he forgets past life experience, and manifests pathological. This is expressed in strange behavior, in stupid actions. A person does not realize all 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 dwelling is unkempt, and his appearance is untidy. Patients often completely ignore personal hygiene. Speech disorders are observed, which is expressed in the most detailed description of absolutely unimportant details. The phrases are rather lengthy and do not make sense. Often such patients adhere to a certain idea and give all their strength to realize it, for example, they count the letters in great works. However, despite the odd behavior, such people are capable of work and study.

Energy potential reduction defect. The circle of interests of such people is narrowed, contacts are limited. The patient tries to avoid any vigorous activity, refuses to work. Does not strive for knowledge, for creative development, often completely passive and indifferent to everything. At home he feels as comfortable as possible and does not want to leave it.

Stages of sluggish schizophrenia

The disease goes through several stages:

Debut or latent stage, which can be invisible even to close people. His symptoms are mild and blurry. The patient has prolonged hypomania, somatized depression, persistent affects. This stage occurs during puberty. Teenagers may refuse to take an exam, stop leaving the house, avoid communication with other people.

manifest or active period when there is an increase in the clinical symptoms of the disease. It is at this time that certain oddities begin to notice 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, experiences fears. In order to overcome them, such people often resort to rituals and rechecks (cleanliness of clothes, their own body, etc.).

Stabilization. The patient behaves absolutely normally, the whole clinic, which manifested itself at the stage of manifestation, subsides. Stabilization can continue for a long time.

Treatment of sluggish schizophrenia

When the diagnosis of schizophrenia is confirmed in a patient, he needs to undergo psychiatric treatment. First of all, it consists in taking medications. It is worth remembering, no matter what remedy the doctor prescribes, it must be taken without gaps. Only strict adherence to the treatment regimen can give a positive effect.

Therapy with traditional antipsychotics. Such drugs are aimed at blocking dopamine receptors. Highly potent traditional antipsychotics are characterized by stronger bonds with dopamine receptors and less strong bonds with muscarinic and adrenoreceptors. Low-potency antipsychotics are used less frequently, as they have a weak affinity for dopamine receptors and a slightly higher affinity for histamine, adrenergic, and muscarinic receptors. The choice of one or another means depends on what route of administration is needed, 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. These drugs include: Chlorpromazine, Thioridazine, Molindone, Thiothixene, Haloperidol, Fluphenazinedecanoate, Haloperidol Decanoate and others.

Antipsychotics of the second generation. These drugs can affect the work of not only dopamine, but also serotonin receptors. Their advantage over the first generation means is less pronounced side effects. The issue 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 drugs, 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. Training of psychosocial skills, programs aimed at the professional rehabilitation of patients must be used. This allows people with sluggish schizophrenia to continue working, take care of themselves, feel comfortable in society.

In no case should close people turn a blind eye to violations in the behavior of a loved one. Only an integrated approach to treatment, together with a psychotherapist, psychologist, social workers, will allow the patient to live a full life.

During the manifest period, hospitalization of the patient may be required. Do not refuse it if the doctor insists on it. However, it is also impossible to artificially delay the patient's stay in a hospital. Staying in the hospital for too long can exacerbate the severity of symptoms. People living in the family avoid exacerbations longer.

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

Forecast and prevention of attacks of sluggish schizophrenia

The disease has a favorable prognosis. With an integrated approach to treatment, seizures will be observed extremely rarely. Such patients will remain active members of society and will be able to fully fulfill their labor duties.

To reduce the risk of recurrence of the disease, it is necessary to adhere to the treatment regimen prescribed by the doctor. Often it is the self-cancellation of drugs that leads to an increase in seizures. In addition, it is important to avoid conflicts in the family, to strive to protect the sick person as much as possible from possible ones.

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

Sluggish schizophrenia is a disease in which the patient has unusual behavior and emotional reactions that are inadequate to the events taking place. At the same time, 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 sluggish schizophrenia and risk group

The causes of the disorder are not yet fully understood. Researchers suggest that the onset of the disease is influenced by a complex of factors: genetic predisposition, personality traits, social environment, the presence of psychotraumatic situations.

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

There are difficulties in how to distinguish and how to recognize low-grade schizophrenia, because the clinical manifestations are similar to many other mental disorders. The disease begins slowly, develops over several years, because of which relatives may not notice violations in human behavior for a long time.

Stages and forms of the disease

The disease goes through the following stages:

1. Latent, hidden stage or debut. The period when the first signs and symptoms of sluggish schizophrenia appear. Most often this happens in teenagers. Symptoms are not very pronounced, so relatives may not notice changes in a person’s character. Often manifested by hypomania and somatized depression.
2. Active or manifest stage. Gradually, the symptoms of the disease begin to appear. There are fears and panic attacks. This is the period when the disease develops. May be continuous or characterized by bouts of increasing symptoms.
3. Stabilization stage. At this stage, the symptoms weaken or disappear completely, the patient returns to the usual forms of behavior.

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

The psychopathic type of disorder is characterized by signs of depersonalization. Patients think they are unable to control their own actions. Patients demonstrate hysterical, insensitive behavior. Often they are embittered and detached, they lose their emotional connection with loved ones. People can have strange hobbies. Often there is a tendency to bad habits, such as the abuse of alcoholic beverages and psychoactive substances.

The neurosis-like form proceeds with the predominant symptoms of fear, obsessive thoughts and actions. A person develops various phobias, including social phobia and hypochondria. People begin to demonstrate compulsive actions, rituals that help them relieve anxiety. This form of the 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 sluggish schizophrenia

Symptoms must have been present for at least 2 years to be diagnosed. People with the disorder are characterized by withdrawal and a desire to move away from loved ones, inadequate emotional reactions, eccentric appearance, non-compliance with generally accepted cultural norms, the presence of paranoid thoughts, signs of depersonalization and derealization, delusions, unusual speech, demonstrative behavior, obsessive thoughts of a sexual and aggressive nature. Sometimes hallucinations may occur.

Among the signs of sluggish schizophrenia in men, there is 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 defiant for everyday life is a sign that is more characteristic of sluggish schizophrenia in women.

Treatment and prognosis of indolent 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. In therapy, tranquilizers, antipsychotics, antidepressants are used.

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

Before you begin drug treatment of sluggish neurosis-like schizophrenia, you should make sure that the patient's symptoms are not caused by neurosis that occurred after a mental trauma. In some cases, it is necessary to consult a neurologist and other doctors to rule out the possibility that the behavior is caused by organic causes.

With the correct implementation of the doctor's recommendations, there is a greater chance of stabilizing the condition. Compared with schizophrenia, patients with schizotypal disorder have a better treatment prognosis. In rare cases, the disorder progresses to 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 in full or in part.