Schizophrenia

Description:

Schizophrenia is a progreduated mental disease, with dissociation, characteristic of it, in mental activity, i.e. loss of unity of mental functions, with quickly or slowly developing changes of the identity of special type (decrease in energy potential, the progressing intravertirovannost, an emotional oskudneniye) and various psychopathological frustration, including circles of syndromes: asthenic, affective, neurosis-like, psychopatholike, crazy, hallucinatory, pseudo-hallucinatory, hebephrenic, catatonic, oneiric.

Endogenous and procedural frustration (heading DSM "Shizofreniya", "Shizoaffektivnoye rasstroystvo", "Shizotipicheskoye rassroystvo") – group of chronic mental endogenous disorders, having natural синдромокинез and синдромотаксис productive and negative symptomatology, proceeding with increase of negative symptomatology which pathognomonic signs are discordant disturbances intellectual мнестические and emotional and strong-willed frustration which development leads 9 progressing of autism to formation of specific emotional and strong-willed defect, apathy, abulia) and which operational diagnosis is carried out with use of criteria of the heading "Schizophrenia" of ISD-10 and DSM-4R.

Istria studying of schizophrenia begins with the second half of the 19th century when in 1871 Gekker described a hebephrenia, and in 1890 Kalbaum for the first time mentioned a catatonia. The era of coryphaeuses of psychiatry begins with the end of the 19th century. In 1911-1930 Bleyer described symptomatology, pathognomonic for schizophrenia, – discordant disturbance thinking, autism, ambivalence, affective dissociation, an ambitendentnost. In 1924 the scientist Bumke allocated nuclear forms of schizophrenia. Continuous and progreduated schizophrenia is described by Kleyst (1953) and Leongardrm (1960). Further Kerbikov, Snezhnevsky, Nadzharov, Tiganov, Zharikov and other scientists dealt with studying with a clinical problem of schizophrenia.

Schizophrenia – quite widespread disease. Morbidity makes from 1,9 to 10 for 1000 the population. Incidence is various, depending on a floor: for men 1,98; for women 1,85. It is noted that men have the continuous and current schizophrenia more. The highest incidence is the share of teenage and youthful age, then the incidence decreases, however schizophrenia meets at any age – from the pre-natal period till an extreme old age.

Schizophrenia reasons:

There is a set of theories of development of schizophrenia, however any of them not was is accepted as unique.
1. The dopamine theory offered by Carson. It is defined that at patients with schizophrenia of persons synthesis of dopamine and hypersensitivity of dopamine receptors is strengthened. Structures with the high content of dopamine: nigro-striatal, mezentsefalno-cortical and mezentsefalno-limbiko-cortical structures. Hypersensitivity of dofaminergichesky receptors in limbic area and a striatum is observed. There is a disturbance of activity of GAMK (gamma аминомаслянной acids), brake substance, the specified receptors influencing on.
2. The etiological role toxic is determined by a factor in connection with similarity of chemical structures of biogenic amines and psikhomimetik. It became clear that structures of noradrenaline and dopamine have much in common with structure of a mescaline. In urine of patients it was allocated диметоксифенилэтиламин that indicates disturbance of methylation of biogenic amines.
3. Dysfunction of neuropeptids. Neuropeptids are a basis of intercellular interaction. Carry neurohormones, neurotransmitters, neuromodulators, chemical carriers of specific information to them.
Disturbances in 3 groups of neuropeptids take place:
a) disturbance of neurohumoral function (vasopressin, oxytocin, thyrotropin – рилизинггормон);
b) neyrotransmitterny function of neuropeptids consists in change of membrane potentials (substance P);
c) neuromodulator function: the endorphines and enkephalins similar on structure to opiates, influence specific receptors and possess psychotropic action.

There are special instructions on genetic aspects in inheritance of schizophrenia. An important role in it is played by the phenomenon of an assortativny funnel of marriages consisting in the following: persons with a similar genotype feel to each other strong sexual desire that eventually leads to accumulation of homozygous descendants in 3-4 generations. The polilokusny (polygenetic) model of inheritance with dominance of recessive genes is characteristic of schizophrenia. Incomplete penetrance, translocations of 3 and 8 couples of chromosomes, concentration of pathological genes in the 5th couple of chromosomes is characteristic.
The contribution of genetic factors in development of schizophrenia reaches 87%, and the type of a current and a syndrome is inherited generally.
The risk to ache with schizophrenia at the relative of a proband (the person sick with schizophrenia):
parents – 14%, brothers and sisters – 15-16%, children of 10-12%, aunts and uncles – 5-6%. However, except risk to ache with schizophrenia relatives have an increased risk of other mental anomalies.

Risk factors at schizophrenia:
1. A factor of X (possibly it is perinatal pathology), which causes damage of a brain with expansion of side ventricles in a puberty. It is considered that if the factor of X did not work in this period, then after the pubertal period schizophrenia does not develop.
2. Perinatal pathology.
3. Schizoid type of the personality.
4. The Shizofrenogenny family (the conformal father is suppressed by stenichny and despotic mother).
5. Kannabinoidama intoxication.
6. Conception of the child in winter months.

There are also etiological factors modeling the schizophrenia reasons:
1. Floor. It is noted that men are ill a continuous and progreduated form of schizophrenia more often.
2. Age. There is a concept of age crisis of development of schizophrenia:
1 age crisis: since the early childhood to 3 years (development of early children's autism);
2 age crisis: preschool and early school age (existence children's fear and bredopodobny imagination);
3 age crisis: teenage age (beginning of low-progreduated and hebephrenic schizophrenia);
4 age crisis: youthful age of 18-20 years (beginning of juvenile malignant schizophrenia);
5 age crisis: 25 – 30 years (paranoid schizophrenia);
6 age crisis: age involution – 33-35 years (shizoaffetivny frustration);
7 age crisis: pathological climax (involutional paranoid, involutional melancholy);
8 age crisis: late age – after 65 years (Ekbom's syndrome, verbal gallyutsinoza of fantastic contents).
3. It is noted that schizophrenia has heavier current at persons with low education, qualification, material level.

Pathogeny:

For the first time pointed out Flore Henry which claimed that it at the heart of paranoid and shizofrenopodobny states lies limbikoretikulyarny defeats of the left cerebral hemisphere neuropsychiatric aspect of a pathogeny of schizophrenia. Further Schweitzer found out that dysfunction of the right hemisphere against the background of hyperreactivity of left is the cornerstone of paranoid schizophrenia. Neduva pointed to interest of diencephalic departments of a brain.
The pathogeny of schizophrenia is presented in the form of the following interconnected stages:
1. Disturbance of development of a brain. Internal hydrocephaly (dilatation of side ventricles) acts as a marker.
2. Disturbance of metabolism of serotonin and methionine with formation of indoles that gives endointoxications.
3. Disturbance in dofaminergichesky system (hypersensitivity to dofaminergichesky receptors). These disturbances cause positive symptomatology at schizophrenia.
4. Serotonergic disturbances are shown in deficit of serotonin, disturbance of sensitivity of serotonergic receptors. Cause discordant disturbances and negative symptomatology.
5. Autoimmune pathology. During exacerbations of schizophrenia increase in concentration of autoantibodies and disturbance of protective function of a blood-brain barrier is observed.
6. Pathological activation of the left cerebral hemisphere promotes development of hallucinatory paranoid symptomatology and discordant frustration. Pathological activation of diencephalic departments  of the right hemisphere promotes emergence of schizoaffective symptomatology and on the other hand – neurosis-like and psychopatholike frustration (at low-progreduated schizophrenia).

Schizophrenia symptoms:

Premorbidal features consist available schizoid lines – isolation, sensitivity, defect of empathy, coldness.
The increased sensitivity in the premorbidal period, before development of strong clinical signs of a disease, consists in very raw sensation as other people treat the person, but he, in turn, cannot feel a condition of the interlocutor.

The types of pathological persons which are found in the premorbidal period of schizophrenia:
1. Without features.
2. Sensitive schizos – vulnerable, reaktivnolabilny, with neurotic reactions, "mimozopodobny".
3. Emotionally cold and expansive schizos - emotionally reduced, with monotonous rigid, supervaluable activity, an effusiveness.
4. Exemplary – sluggish, passive, obedient, judicious, with sluggish instincts.
5. With existence of a disproportion between high intelligence and motor awkwardness.
6. Unstable, excitable, with the stirred-up inclinations and motility.
7. Cycloid.
8. Hysterical persons.
9. Psychasthenic persons – alarming and hypochondriac, with a reflection, tendency to a heart-searching, uncertainty.
10. Asthenic persons with sensitivity, weakness, increased fatigue.
11. Pedintichno-rigidnye (anankastny) persons.
12. Paranoic persons – expansive, sensitive, sluggish fanatics, "fighters for justice".
13. Infantile persons with long remaining children's style.

Productive frustration at schizophrenia.
1. Neurosis-like frustration:
a) with dominance of asthenic frustration (slackness, fatigue, irritability), creation of the particular sparing treatment, an oligothymia;
b) inadequate fears are stereotypic and ridiculous (at children);
c) with dominance of the phenomena of persistence, feeling of shyness, an oligothymia, phobias, later – system of rituals and a mentism with fear to go crazy;
d) with dominance of depersonalization and a derealization;
e) not crazy dismorfofobichesky and dismorfomanichesky ideas;
e) hypochiondrially - senestopathetic states;
g) incidental ideas of the relation, calls, separate and non-constant mental avtomatizm.

2. Psychopatholike frustration:
      a) the increased affective lability;
      b) a state with a giperstenichnost, monotonous activity, tendency to paranoic reactions and unstable supervaluable education;
c) psychopatholike states with the increased sensitivity, tendency to the unstable separate ideas of the relation;
d) states with dominance of hysterical frustration of which tearfulness, a capriciousness, tendency to quarrels, vazo-vegetative lability is characteristic;
e) psychopathological states with a hyperexcitability and geboidny frustration;
e) the states including the incidental ideas of the relation, calls, separate mental avtomatizm.

3. Supervaluable educations:
a) unusual autistic interests and games, autistic imaginations of supervaluable character (at children). The ridiculous collecting, stereotypic games alone deprived of practical value;
b) the phenomena of metaphysical intoxication – a rudimentary paranoyalnost excitedly abstract philosophical doctrines and the modernistichesky directions. This hobby has no productive character;
c) supervaluable disformofobiya and mental anorexia. Confidence available defect of appearance or completeness, the sensitive ideas of the relation, a subdepression, the aspiration to korregirovat the revealed defect.

4. Unsharply expressed affective frustration:
a) subdepressions of tsiklotimopodobny level with daily mood swings;
b) adynamic (apathetic) subdepression;
c) a hypomania of tsiklotimopodobny character with increase in mood, motor and intellectual performance, roughness, sharpness, disinhibition;
d) a hypomania with psychopatholike behavior;
e) repeated subdepressions with short remissions;
e) frequent change of hypomaniacal and sublepressivny states with short remissions;
g) continuous change hypomaniacal and subdepressions.

5. Affective syndromes:
a) a depression with navyazchivost;
b) depression of endogenous type, including self-accusations, anestetichesky with the ideas, and condemnations;
c) a depression with alarm and agitation;
d) maniacal conditions of circular type – the level of a psychotic mania;
e) the mixed not crazy affective states.

6. Affective and crazy syndromes:
a) an endogenous depression with a persecution complex and/or hypochiondrial nonsense;
b) depressions with hallucinations and pseudohallucinations;
c) maniacal and crazy states;
d) manias with hallucinations and pseudohallucinations;
e) depressive and paranoid states from intermetamorfozy;
e) acute paraphrenic states.

7. Affective and catatonic states:
a) depressive and catatonic state;
b) maniacal and catatonic state;
c) maniacal гебефренные symptoms.

8. Oneiric states:
a) the reduced oneiric states with lability of affect, fear, a mania with confusion, figurative and sensual nonsense without a certain plot;
b) oneiric and affective states (the oriented oneiroid, a combination of true and fantastic orientation);
c) oneiric and catatonic states (true oneiroid);
d) fibrilno-catatonic states.

9. Acute crazy syndromes:
a) acute sensual delirium;
b) acute paranoiac state;
c) acute syndrome of Kandinsky-Klerambo;

10. Paranoiac states:
a) nonsense of claim, supervaluable nonsense, dismorfomaniye of paranoiac character. The painted nonsense monothematic affektivno takes place. Patients are obsessed with the idea of psychological clearness of nonsense. The nonsense of a reformatorstvo, litigious nonsense, hypochiondrial, disforfomanicheskiya, jealousy, sensitive nonsense of the relation, erotomanicheskiya is possible;
b) paranoiac nonsense with affective fluctuations;
c) resistant paranoiac nonsense.

11. Chronic paranoid states.
12. Paraphrenic states.
13. Other crazy states.
14. Katatono-paranoidnye states.
15. Catatonic states:
a) catatonic and katatono-hebephrenic fozbuzhdeniye;
b) catatonic stupor.
16. Final states:
a) followed by underdeveloped or non-constant catatonic symptoms of a catatonic circle. The microcatatonic symptomatology is characteristic;
b) conditions of a catatonic akinetic circle;
c) conditions of type hyperkinetically - a catatonic circle;
d) with dominance of fantastic nonsense;
e) conditions of hallucinatory-dilision type;
e) conditions of katatono-crazy and katatono-hallucinatory type.

Treatment of Schizophrenia:

Treatment of patients with schizophrenia in a stage of an aggravation has to be done in stationary conditions. However, as practice of the last years shows, a part of patients can receive rather high-quality therapy in semiportable and out-patient conditions. Maintaining patients in less stigmatized conditions provides earlier recovery of social functioning, allows to keep social relateds, to involve in therapeutic process of relatives of the patient. But there are situations in which hospitalization of the patient, is only the right decision: psychomotor excitement, consciousness disturbance, asocial behavior of the patient, impossibility to provide the due level of life activity, the asocial maintenance of productive symptomatology, existence of the conflicts in a family, autoagressivny behavior, existence of komorbidny somatic pathology.
Schizophrenia – a disease with essentially favorable current since at the correct treatment at an overwhelming part of patients there occurs long and high-quality remission. Therapy of schizophrenia represents a complex of medicamentous, psychotherapeutic, intensive and other ways of influence on a disease etiopathogenesis.
The main group of drugs used at schizophrenia are called neuroleptics. According to classification, 9 classes of neuroleptics are allocated:
1. Fenotiazida (aminazine, neuleptil, majeptil, Theralenum)
2. Xanthenes and thiaxanthenes (chlorprothixene, клопиксол, флюанксол)
3. Phenyl propyl ketones (haloperidol, trisedyl, Droperidolum)
4. Piperidinovy derivatives (имап, blackamoor, Semapum)
5. Bicyclic derivatives (рисполепт)
6. Atipichesky tricyclic derivatives (leponexum)
7. Derivatives of benzodiazepines (olanzapine)
8. Indolovy and naftolovy derivatives (мобан)
9. Derivatives of benzamides (Sulpiridum, Metoclopramidum, амисульприд, тиаприд)

Neuroleptics (anti-psychotics) influence dopamine system and are antagonists of dopamine receptors. Their action leads to an antipsikhotichesko to effect. The disturbances in serotonergic system causing negative symptomatology are stopped also by neuroleptics. Action of neuroleptics causes side effects, first of all eksrapiramidny disturbances. The latest neuroleptics, or atypical anti-psychotics (рисперидон, olanzapine) have equal similarity to dopamine and serotoninovy receptors, by efficiency are comparable with classical neuroleptics, and are much better transferred. Each of neuroleptics has specific features of pharmakodinamichesky activity. Neuroleptics in small doses eliminate affective, alarming and phobic, obsessivno-compulsive, somatoformny frustration and compensations of anomalies of the identity first of all of endogenous and procedural character. In high doses neuroleptics reduce psychomotor activity and have antipsychotic effect. Also they render antiemetic effect. Neurotropic action of neuroleptics causes extrapyramidal and vegetative symptomatology.
Except neuroleptics, for treatment of schizophrenia anditepressant, timostabilizator, tranquilizers and other groups of drugs use.
An important role is played by psychotherapeutic work, different trainings. physiotherapy.