Recommendations for relatives of patients with schizophrenia

A person who behaves strangely, eccentrically or aggressively is called a schizophrenic. Meanwhile, how many of us know what this disease – schizophrenia – is? Unfortunately, the average person’s knowledge about this disease is limited to common clichés.

Schizophrenia can affect both men and women. In men, schizophrenia has its own characteristics. Is it possible to recognize schizophrenia in the early stages, and what to do if a loved one receives a similar diagnosis?

Spreading

According to various sources, 0.5-1% of people suffer from schizophrenia. Previously, it was believed that the disease was evenly distributed in the human population. In fact, this is not true. Schizophrenia primarily affects residents of developed countries, but in developing countries the disease is rare. On the other hand, the disease manifests itself in representatives of low-income strata of society. The chance of developing schizophrenia is much higher among city residents than among rural residents.

The opinion that schizophrenia is predominantly a male disease is also unfounded. It has been established that women and men get sick with approximately the same frequency. However, in men, the signs of the disease are often more pronounced. Schizophrenic men are more likely to display aggressiveness, inappropriate behavior, and also express more fanciful delusional ideas than schizophrenic women. This is why men are more likely to become patients of psychiatrists. Schizophrenia in men is observed on average at a younger age than in women. The peak incidence in men is 20-28 years old. Single men get sick 4 times more often than married men.

In older men (over 50 years old), schizophrenia usually does not manifest itself. Schizophreniform symptoms at this age are usually caused by dementia, vascular lesions of the nervous system.

For reasons that are not entirely clear, there is a dependence of the incidence on the time of year in which the patient was born. People born in spring and winter are more likely to suffer from this disease.

Is schizophrenia a genetic disease or not?

If you retell a very strange dream and explain that you find many similarities in it with real life, will they think that you have schizophrenia? Or are you he? How to recover after the loss of a loved one and not go crazy with grief? At what point in time will your inner voice tell you that your soul no longer hurts? Or will he begin to talk to you in the voices of strangers and show you calming dreams that turn into your personal reality? This is the main question of the emergence of schizophrenia as a genetic disease or acquired. But even in relation to people who commit actions from a range of normal behavior, psychology finds explanations for the state of the body that are not related to the stages of the disease:

• frustration;
• affect;
• depression;
• euphoria;
• apathy;
• autism (the origin of which is also vigorously debated by experts).

There is an opinion that schizophrenia is not a hereditary gene, but a common gene of humanity that arises against the background of personal perception of any situation that arises in life once or is repeated with precise frequency, which allows the development of the disease to begin. In addition, in women, manifestations of schizophrenia are recorded to a greater extent than in men. Which confirms this theory, because the female sex is much more likely to pass everything through the heart.

The danger of schizophrenia

Schizophrenia is dangerous not only because the patient loses communication abilities and social significance and becomes dangerous to society. Patients are often characterized by suicidal behavior; they may make suicide attempts, including successful ones. Largely due to frequent suicides, life expectancy for people suffering from schizophrenia is 10 years less than standard. Also, the development of the disease can lead to persistent dementia - a schizophrenic defect. Schizophrenia is one of the leading causes of disability, surpassing in this regard such a factor as blindness.

Recommendations for relatives of patients with schizophrenia

Schizophrenia is a long-term disease, characterized by various manifestations at one time or another. During an exacerbation of the disease, the clinical manifestations are the same, but during remission the manifestations are completely different. Certain oddities in the actions, behavior and thinking of patients persist for quite a long time even in the case of successful treatment of the disease.

Our clinic offers patients modern treatment and rehabilitation programs. However, the best effect is achieved only when the patient’s family members implement the correct behavior patterns. Then a favorable psychotherapeutic atmosphere is created around the patient, which guarantees a successful outcome of therapy in general during the treatment of schizophrenia.

The following are recommendations for relatives. Of course, they may differ slightly at different periods of the course of the disease, but general psychotherapeutic recommendations and principles remain approximately the same:

1. You must follow all recommendations and instructions of your attending physician, psychotherapist or psychiatrist. This includes adherence to the general regime, rest and nutrition. It should be remembered that a patient with schizophrenia should never be offered or given drugs or alcohol! They aggravate the symptoms of the disease.
2. Considering that recovery is usually not quick, you should have more patience, patience and more patience. Haste and the desire to “speed up the treatment process” often lead to the opposite result. There is no need to rush things; it is better to temporarily lower your expectations. You can use your own observations of the progress of treatment and further rehabilitation, comparing the results obtained this month, for example, with the previous one.
3. Does your loved one live with you during treatment? Then you should pay attention to every change in his well-being, remember and write them down. These should be reported to your consultant or treating physician.
4. Each family member needs to know the restrictions and rules that will be valid in your family for the entire duration of the patient’s treatment. It is advisable to immediately establish these rules, which will help quickly put everything in its place in your family.
5. We must remember that everyone needs a break. Therefore, give each other the opportunity to rest. If you are tired of something, and this can sometimes happen, you need to discuss everything among your loved ones, or even better, when meeting with your doctor. After all, sometimes it’s absolutely normal to say the word “no” even to a loved one.
6. It is worth doing all your family chores in the same way as usual. Disrupting the usual order of doing housework is inappropriate. It is necessary to keep in touch with your friends and relatives. In this regard, you will receive invaluable assistance from our highest category psychotherapist Ivanov.
7. There is no need to get stuck thinking that you can’t change, fix or speed up a lot of things. Temporarily, it is better to leave something in your family as it is, without any changes. Unacceptable phenomena in the family are cruelty, indifference, and rudeness.
8. It is necessary to understand that each person’s recovery process is purely individual and proceeds as quickly as possible for this particular patient.
9. The main thing that relatives can do during the treatment process is to remain as calm as possible. You may agree or, on the contrary, disagree with the therapy, the interpretation of the results during treatment - remain calm. Your relative cannot feel, see, or hear any of your doubts, or, conversely, any unfounded, excessive enthusiasm. You should always remember that you are not only not doctors, but also not psychiatrists, so you may be wrong
10. It is advisable to express yourself “simpler”. If you want to say something to a sick relative, you should say it clearly, confidently and calmly.
11. All problems that arise should be solved gradually, step by step. You should solve one problem first and then take on another. Your sick relative may simply be afraid of something new, some kind of change.

If you are a relative of a schizophrenic patient and need professional support, contact our clinic. Psychologists, psychotherapists, and psychiatrists receive appointments here. We will help you regain peace of mind and develop correct behavior in the family.

Make an initial appointment by phone (812) 407-24-26

Kinds

Schizophrenia is a disease that has characteristic symptoms. However, not always all of them can be present in the patient at the same time. Based on the presence of certain symptoms of the disease, several of its main forms can be distinguished:

• catatonic,
• hebephrenic,
• paranoid,
• simple,
• undifferentiated.

There are also rarer forms of schizophrenia:

• children's,
• atypical,
• senestopathic,
• hypochondriacal,
• latent,
• pseudoneurotic,
• pseudopsychopathic,
• paranoid,
• poor symptoms.

The principle of dividing schizophrenia into different types is based on the traditional approach to treating the disease. Recently, however, it has been criticized as unnecessary and not conducive to improving the treatment of the disease.

Paranoid form

The paranoid form is one of the most severe and most common. First of all, with it, positive signs are observed that prevail over the negative ones. The patient often demonstrates aggressive behavior and can be dangerous to others. Delirium (the state of a patient who talks about things that obviously do not take place in reality), audio or visual hallucinations are almost always observed.

Catatonic form

The main signs of the catatonic form of schizophrenia are movement disorders. The patient can take various, often uncomfortable, positions and freeze in them. Sometimes, on the contrary, there is increased motor activity. Periods of stupor and activity may alternate. Delusions and hallucinations are also observed, but most of the time the patient's consciousness is clear. Treatment of the catatonic form during exacerbations is carried out in a hospital.

Hebephrenic form

The hebephrenic form of schizophrenia often manifests itself in men in adolescence, starting at 14-15 years of age. With this form, deviations in behavior are mainly observed. A patient with this form of the disease behaves eccentrically, fools around, laughs for no reason, makes faces and grimaces, dresses sloppily and sloppily. There are also negative signs that progress quickly. Delusions or hallucinations may occur but are not the predominant symptoms. All this leads to early disability or learning disabilities. The hebephrenic form is usually difficult to treat and actively progresses, especially in adolescence.

Other types of disease

A simple form of schizophrenia is a type of disease in which negative signs are primarily encountered (apathy, flattening of affect, autism, decreased volitional qualities). With a simple form, any eccentric deviations in behavior may be absent. An undifferentiated form is also often found. With it, signs characteristic of hebephrenic, paranoid and catatonic forms can be observed.

Schizophrenia: recommendations for relatives

Schizophrenia is a long-term disease, its course has different manifestations in different periods. During the period of exacerbation of the disease, the clinical manifestations are the same; during the period of remission, the manifestations are completely different. Oddities in the behavior, actions and thinking of patients persist for quite a long time, both against the background of modern treatment and during remission.

Modern psychotherapy can be as effective as possible only when it is carried out not only in combination with the patient’s treatment, but also with the correct behavior and attitude towards the person from relatives and loved ones from a psychotherapeutic point of view. Then a favorable psychotherapeutic environment is created around the patient, which guarantees a successful outcome of therapy in general in the treatment of schizophrenia.

Recommendations for relatives may be different at different periods of the course of the disease, but general psychotherapeutic principles and recommendations remain approximately unchanged.

1. It is necessary to follow all instructions and recommendations of the attending physician - psychiatrist-psychotherapist. This includes adherence to the general regime, diet and rest. Remember that drugs and alcohol are contraindicated for a person with schizophrenia! They worsen the symptoms of the disease. This also applies to medications that a person takes carelessly or prescribes for himself.
2. Considering that the recovery process, as a rule, is not quick, no matter how much everyone would like it, therefore you need to be patient. Haste and the desire to “speed up the treatment process” most often lead to the opposite results. Stop rushing things and lower your expectations temporarily. You can use your own observations and impressions of the treatment and rehabilitation process, comparing the results achieved this month with the previous one.
3. Does your loved one live with you during treatment? Then pay attention to all changes in his health, remember and write them down. Please report them to your treating or consulting physician. Each family member should know the rules and restrictions that will apply in your family for the entire period of treatment of a loved one. It is advisable to immediately establish rules that will quickly help put everything in its place in your family.
4. Remember that everyone needs a break. Give each other a chance to rest. If you are tired of something, and sometimes this can be the case, you need to discuss everything among your loved ones, or better yet, when you meet with a doctor. After all, sometimes it’s completely normal to say the word “no.”
5. Carry out all your family activities as usual. It is not advisable to disrupt the usual order of doing housework. Keep in touch with your relatives and friends. A psychotherapist will provide you with invaluable assistance with this.
6. It makes no sense to be fixated on the idea that you cannot change, speed up or fix much. Temporarily, something in the family needs to be left as it is, without changes. Unacceptable phenomena in the family are indifference, cruelty, and rudeness. A person with a disorder is especially defenseless and especially needs your care, attention, and affection.
7. It must be remembered that for each individual the recovery process is purely individual and proceeds as quickly as it can for this particular person.
8. The most important thing that relatives can do for the therapy process is to remain calm. You may agree or, conversely, disagree with the treatment, interpretation of the results during therapy - remain calm. Your relative should not see, feel, hear either your doubts or your excessive, unfounded enthusiasm. Always remember that you are not only not doctors, but also not psychiatrists, so you can make mistakes, which professional psychiatrists should not do.
9. It is advisable to communicate simply and clearly with people with schizophrenia. If you want to say something to a family member with a disorder, speak clearly, calmly, and confidently.
10. Solve all problems that arise gradually, step by step. If changes need to be made, do so gradually, step by step. It is most effective to work and solve one problem and then the next. Your loved one is often afraid of new things and changes.

Course of schizophrenia

The disease can have either a continuous or paroxysmal course. In the latter case, periods of remission may be observed between attacks. Typically, without treatment, exacerbations become longer and more severe. The first symptoms of an attack of illness are usually negative.

In the continuous form, there are no remissions, and the disease gradually progresses. The patient quickly loses all necessary life skills, stops communicating with loved ones, going to work, caring for himself, etc.

Previously, some psychiatrists also identified a sluggish type of schizophrenia, but now in world practice, moderate schizophreniform symptoms that do not tend to worsen are classified as personality disorders, in particular schizotypal, and not schizophrenia.

Causes

The causes of schizophrenia are still not precisely understood. Previously, it was believed that the disease was completely hereditary. However, modern science disputes this statement. True, the disease really most often manifests itself in people who have a family history of patients with this disease. Certain genes that are transmitted through the maternal line are responsible for the tendency to the disease. It is estimated that approximately 10% of people have a genetic predisposition to the disease.

However, it cannot be said that the disease is primarily due to heredity. Social and psychological factors play an equally important role. These are, in particular, the conditions of upbringing, episodes of domestic violence, and psychological shocks in childhood. Perhaps the conditions of fetal development in the womb play a role. For example, with infectious and autoimmune diseases suffered by the mother, damage to the child’s brain tissue is possible, subsequently leading to illness.

Factors causing schizophrenia in adulthood

In adulthood, the psyche is already much more stable, and the nervous system is formed. Therefore, the influence of biological and psychological factors is less than in childhood. However, severe stress, life's adversities, and conflicts in the family can also provoke the development of the disease.

First of all, people at risk are:

• with an emotionally unstable nervous system,
• prone to addiction,
• with low material income,
• suffered head injuries,
• survivors of severe somatic illnesses,
• having personality disorders of schizoid and schizotypal types,
• living alone.

Causes of attacks and exacerbations

The appearance of attacks of the disease can be provoked by the following factors:

• stress,
• conflicts in the family or at work,
• bright lights and loud sounds,
• injuries,
• weather change.

It is well known that many patients (approximately 98%) experience exacerbations in the off-season (autumn and spring), but in winter and summer the condition usually remains stable. This factor is associated with sudden changes in temperature and changes in the length of daylight hours, which, in turn, causes fluctuations in serotonin levels. All this knocks the patient out of his usual rut and leads to complications in the course of the disease. The more pronounced the change of seasons in a certain area, the more severe seasonal exacerbations can be.

Therefore, in the off-season, the patient requires a routine examination by a psychiatrist, who can prescribe a course of medications. It is also recommended to avoid stress and alcohol consumption during problematic times of the year.

Impact of drugs and alcohol

It is also generally accepted that alcoholism and drug use contribute to the onset of schizophrenia in men in adulthood. However, this connection cannot be considered precisely established, since it is not always possible to find out what was the first in the patient - an addiction to the use of psychoactive substances or a schizophrenic disorder. After all, the patient may resort to alcohol and drugs as a means of alleviating the symptoms of schizophrenia.

Is schizophrenia inherited from the mother?

It is equally important to definitely identify the exact probability of transmission of schizophrenia through heredity through the female line. It is in this case that the risk of disease increases many times

The likelihood of a son or daughter getting the disease from a mother increases at least fivefold. This figure far exceeds the risk level in cases where the pathology is diagnosed in the father of the children.

It is in this case that the risk of disease increases many times. The likelihood of a son or daughter getting the disease from a mother increases at least fivefold. This figure far exceeds the risk level in cases where the pathology is diagnosed in the father of the children.

It is quite difficult to make any definite predictions with complete confidence, since the general mechanism of the development of schizophrenia has not yet been fully studied. However, scientists are inclined to believe that a chromosomal abnormality plays a huge role in the occurrence of the disease.

Infectious or respiratory diseases that affect the fetus during gestation also give rise to various diseases.

It is precisely such influences that are responsible for the fact that people who were subsequently diagnosed with this severe mental pathology celebrate their birthday at the very peak of spring or winter infection with viral infections.

The hereditary development of schizophrenia in children is aggravated by:

• very difficult mental conditions of the early development of a daughter or son affected by the disease;
• lack of full care for the child;
• pronounced changes in the baby’s metabolism;
• organic brain damage;
• biochemical pathology, etc.

Whether the parents suffered from the disease on the male or female side is very important, but not decisive.

Very often, a woman is affected by schizophrenia in a sluggish form, which goes unnoticed by her family members, medical professionals, or psychiatrists.

Often, a special mutated gene that she happened to inherit from relatives is recessive, without having much of a chance to express itself in its entirety.

It is equally important to definitely identify the exact probability of transmission of schizophrenia through heredity through the female line. It is in this case that the risk of disease increases many times. The likelihood of a son or daughter getting the disease from a mother increases at least fivefold

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This figure far exceeds the risk level in cases where the pathology is diagnosed in the father of the children.

The likelihood of a son or daughter getting the disease from a mother increases at least fivefold. This figure far exceeds the risk level in cases where the pathology is diagnosed in the father of the children.

Very often a woman is affected, which goes unnoticed by her family members, medical professionals, or psychiatrists.

Mechanism of disease development

The pathogenetic mechanism of the disease has also not been thoroughly studied. There are various theories linking the occurrence of the disease with changes in the sensitivity of receptors of various neurotransmitters located in the central nervous system - dopamine or glutamine. The dopamine theory is supported, in particular, by the fact that excess dopamine in the nervous system can lead to symptoms of the disease such as delusions and hallucinations. However, to date there is no theory that could explain the variety of symptoms observed in schizophrenia.

History of the treatment of schizophrenia

In the 50s of the last century, the first antipsychotic was synthesized - chlorpromazine (aminazine). Until this time, antipsychotics were absent from the arsenal of psychiatrists; patients with mental disorders were kept in hospitals without the use of the necessary antipsychotic therapy, which is the mainstay for the treatment of this disease. Mental patients were fixed, doused with cold water, bloodletted, opium and other sedatives were used, and arsenic and mercury were given. One of the most effective methods in the treatment of schizophrenia in the past was insulin therapy, which is now considered obsolete.

At that time, it seemed that the discovery of antipsychotics would become a panacea for mental illness, like the antibiotics first synthesized by Fleming. But the optimistic expectations were not entirely correct. After all, classical antipsychotics had many side effects, which made them very difficult to take long-term and to function normally. This prevented the necessary long-term anti-relapse therapy. In addition, treatment-resistant forms of schizophrenia remained.

Over time, atypical neuroleptics appeared on the pharmacological market - drugs that affect not only dopamine receptors, but also serotonin receptors and have a much less pronounced range of side effects, like classical neuroleptics.

In the practice of a modern psychiatrist, atypical antipsychotics are gradually replacing typical ones, and this is the right path. After all, doctors used to have a clear task - to remove delusions and hallucinations so that they did not affect the patient’s behavior, and it was orderly. However, at the same time, side effects developed that caused significant damage to the patient’s health during long-term treatment and made its use impossible.

At the present stage, the goals in the treatment of schizophrenia are not only the relief of productive symptoms (delusions and hallucinations), but also minimizing the risk of re-exacerbation. And the most important task is to restore the patient’s socio-psychological and productive functions to the pre-morbid level, his social and professional reintegration. Atypical neuroleptics make it possible to solve the above goals and objectives of schizophrenia treatment not only due to their wider spectrum of action (levelling productive and negative symptoms), but also because when they are used, there is a significantly lower severity of side effects than with typical antipsychotics. This allows patients with schizophrenia to use the necessary anti-relapse therapy for a long time, if necessary, and feel satisfactory.

How it manifests itself and how to recognize it at the initial stage

Psychiatrists divide all signs of schizophrenia into productive (positive), negative and cognitive.

Productive symptoms include those that are noticed by others first:

• rave,
• hallucinations,
• catatonia,
• inappropriate and stupid behavior,
• speech disorders.

Negative (psychodeficiency) usually includes signs that are not particularly noticeable outwardly. This:

• apathy;
• abulia (weakening of will);
• loss of professional skills;
• lack of interest in anything (family, work, hobbies);
• desire for solitude, lack of sociability;
• sleep disorders;
• nightmares;
• impoverishment, flattening and inadequacy of emotional reactions;
• ambivalence (contradictory attitudes towards the same person);
• uncleanliness;
• sloppiness, disdain for appearance;
• decreased sexual desire;
• inability to enjoy anything (anhedonia).

If there are negative signs, the dynamics of their development is important. That is, if a man was previously sociable, and then withdrawn into himself for no reason, then this is a reason to be wary. However, a person could initially be uncommunicative, timid, and avoid noisy companies - these are, of course, character traits, and not evidence of mental illness. The tendency to sloppiness and carelessness should be assessed in the same way. Such a sign, if it is permanent, can be attributed to shortcomings in a person’s upbringing. But if the patient’s appearance gradually deteriorates, then this is a reason to suspect mental illness. The thing is that with schizophrenia, routine activities such as dressing, washing or shaving become unbearably burdensome for a person.

It is also necessary to keep in mind that men are by no means prone to abundant expression of feelings due to cultural attitudes and characteristics of the nervous system. This means that the apparent emotional coldness of some men in itself is not evidence of mental illness; the dynamics of the development of a person’s condition are also important here.

Cognitive impairment

Cognitive symptoms include disturbances in thinking, perception, attention, memory deterioration, and difficulty concentrating on any subject. However, if the disease does not take a severe course, then the patient’s level of intelligence is not seriously affected. However, the ability to perceive and accumulate information and make independent decisions is impaired.

Speech disorders

Speech disorders can be expressed in a loss of coherence between individual words, phrases and sentences. A person can move from one thought to another without any reason. In severe cases, speech often consists of one set of phrases, between which it is not possible to discern a logical connection. The patient's speech may become unintelligible, and he may utter incoherent screams.

Emotional symptoms

The patient’s attitude towards close people – his wife, mother – may change for no apparent reason in a negative direction. A man can retire for a long time, lock himself in his room, and refuse to eat.

Mood changes are common - sudden moodiness, outbursts of anger, irritability. Changes in the patient's facial expressions are also possible. She usually becomes poorer. This is often expressed in the fact that the patient’s face becomes stony during a conversation and expresses a minimum of emotions. Slow flashing may occur. In other cases, on the contrary, facial expressions may become more active. Twitching of the corners of the mouth is characteristic. Tremor-like twitching of the limbs may also be observed.

The emotional coloring of the voice may also disappear; it becomes monotonous and mechanical. Patients do not like direct eye contact and tend to look away when speaking.

Movement disorders

Motor disturbances are usually classified as catatonia. It can be expressed in the fact that the patient often sits motionless or, conversely, exhibits excessive but meaningless motor activity. Human movements lose their naturalness; they are characterized by some mannerism.

Alcoholism and drug addiction

Often a man, under the influence of symptoms of schizophrenia, begins to drink and use drugs. This can make it difficult to make a diagnosis, since symptoms of the disease are often associated by others with alcoholism and drug addiction, and not with a mental disorder.

Hallucinations

Visual hallucinations are observed in approximately half of patients. Hallucinations can be not only visual, but also auditory. The auditory type of hallucinations is observed more often than the visual type. Approximately 3/4 of patients experience auditory hallucinations. Hallucinations can also be olfactory or tactile.

Most often, auditory hallucinations manifest themselves in the form of voices of some people, spirits, etc. Sometimes a man thinks that his thoughts are heard in his head. Voices can simply discuss a person, comment on his actions, or order him to do something. Under the influence of these orders, a man may harm himself or others.

With visual hallucinations, a person can see some people, usually unpleasant to him, and sometimes even dead.

Often hallucinations can be mixed - auditory and auditory.

It can be difficult to determine the presence of hallucinations in a patient if he himself does not talk about them. The fact that the patient is experiencing hallucinations can be concluded from the fact that he often talks to himself or to emptiness, turns around or listens to something for no reason.

Delusional ideas

Delusions are thought disorders in which the patient believes in certain things that obviously do not exist in reality. The important thing here is that delusion is a stable system of beliefs that cannot be changed by outside influence. Of course, any person can be mistaken, but under the influence of undeniable facts and arguments, a normal person, unlike a schizophrenic, always changes his mind.

Types of delusions observed in schizophrenia in men:

• persecution
• greatness,
• relationship,
• influence
• jealousy,
• reformism,
• impact,
• invention.

Delusional relationship

With this type of delusion, it seems to a person that all the eyes of those around him are directed at him, as if all the people are constantly discussing him and criticizing him, laughing at him behind his back. Sometimes delirium is accompanied by auditory hallucinations that reproduce the voices of people discussing the patient.

Delusions of persecution

The most common type of delirium. With delusions of persecution, the patient thinks that someone is watching him and watching him all the time. These could be aliens, intelligence officers, or just neighbors. The patient finds objects everywhere, even in an ordinary room, through which observation is carried out.

Delirium of influence

With this type of delusion, it seems to a man that his actions are being controlled by someone or something. Again, these could be some kind of special services, spirits or aliens, and sometimes ordinary people. Control over the patient, in his opinion, is carried out with the help of some invisible rays, telepathy, witchcraft, etc. Very often, voices in the head that appear during auditory hallucinations act as such controlling substances.

Delusions of grandeur

With delusions of greatness, invention and reformation, the patient considers himself a person much superior to the people around her, in some sense unique. This view inevitably leads to conflicts when dealing with other people. And sometimes a person with delusions of grandeur isolates himself from other people, considering them unworthy of communication.

Other signs

Sleep disturbances often occur. They can be expressed not only in insomnia, but also in the fact that a person can completely change the rhythm of sleep and wakefulness. At night he may feel a surge of energy, and during the day, on the contrary, drowsiness.

The patient may begin to show increased interest in mysticism, religion, occultism, parapsychology, and esotericism. He tends to associate the hallucinations that a person sees with the influence of the other world, aliens, demons, etc. He may begin to believe that someone is stealing thoughts from his head and putting others in their place.

During the stages of remission, patients may develop schizophrenic depression.

Recognition in the initial stages

There are several stages of the disease.

Name	Symptoms
First stage (mastery)	The first stage is characterized by maintaining performance. Changes in the psyche can only be detected by people close to a person. At the first stage, mild mental disorders, apathy, sloppiness, and fears may be observed.
Middle stage (adaptation)	The transition of the disease to the second stage leads to the fact that the person adapts to his mental characteristics. Positive manifestations of the disease (hallucinations and delusions) become chronic. This stage requires urgent treatment.
Last stage (degradation)	This stage means that a person’s mental reserves are exhausted. The patient is lost in space and time and behaves completely inappropriately. This stage threatens the patient with the development of dementia.

Determining the disease in the first stages is very difficult even for a qualified psychiatrist. And there is no need to talk about unprepared people here. However, there are a number of symptoms that should alert people around you.

Very often, the manifestation of the disease is preceded by a prodromal stage. This stage of schizophrenia in men may be accompanied by:

• alienation,
• irritability,
• constantly in a bad mood,
• mild aggressiveness.

Of course, such manifestations can also be a symptom of neurotic disorders and are not always the first signs of the disease.

What is our understanding of schizophrenia?

A schizophrenic is a person whose thinking and reasoning go beyond the usual, objective ones. Some examples of the disease are extremely vague in description. Schizophrenics suffer from hallucinations. In human terms, they “live in their own personal world” and are unable to maintain the thread of the conversation, constantly moving the dialogue in the desired (or beneficial) direction for themselves. They commit acts of an abnormal nature for no apparent reason. They do not accompany their actions with explanations, or they explain their intentions in such a way that it sounds beyond the bounds of fantastic stories.

A person in the stage of schizophrenia either remains in a perpetual depressive state, withdraws into one mood, or “releases his soul” into the world of illusions that block his pain and suffering acquired in the adequate state. Such people hear sounds, extraneous voices, can talk to them, or experience non-existent episodes and are able to describe them in vivid colors.

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However, this disease is not diagnosed like a common acute respiratory infection: “So, a sore throat, a stuffy nose, a fever - the diagnosis is clear.”

The first signs of schizophrenia in men: behavior

The first signs of schizophrenia in men can be varied. The disease does not always start vigorously, with clearly visible positive signs. Most often, negative symptoms predominate in the patient in the first stages. A person loses interest in work and hobbies, becomes unsociable, and avoids communication even with close people. Sometimes a person can talk at length and at length on some topics that have little connection with reality.

Initial signs at 30 years old

The initial signs of schizophrenia in men very often appear at the age of 25-30 years. Most often this is a paranoid form, which is easily identified by characteristic signs (delusions, hallucinations). But the development of simple schizophrenia is also possible. It is necessary to pay attention to a man’s attitude towards his work, hobbies, and those around him. If a person no longer cares about familiar things, he has become unsociable and withdrawn, then this is a reason to be wary, since we may be talking about the initial stages of the disease. It is also worth paying attention to the man’s sudden sloppiness. All these phenomena may be the first signs of the disease.

Signs at 40

At the age of 40, the manifestation of schizophrenia in men does not occur as often as at a younger age. Initial symptoms may be subtle and not particularly noticeable. A man can become sloppy, give up work and hobbies, and begin to isolate himself from people. The first stage of the disease is also characterized by a change in the patient’s speech – it becomes less coherent. A schizophrenic may often begin to talk about some abstract and obscure topics for others. The patient's emotional reactions also change. He becomes generally emotionally colder. This first sign is not always noticeable in men, because men usually tend to show less emotion compared to women. And a schizophrenic can react paradoxically to some situations. For example, he can react to sad events with laughter, and to joyful ones - with crying.

Classification

According to its forms, congenital schizophrenia is divided into:

• Paranoid. With it, delusional ideas of persecution, conspiracy, jealousy, etc. arise. There are also hallucinations that can be of a different nature (auditory, visual, gustatory);
• Hebephrenic. The main clinical manifestations are inappropriate behavior, disruption of speech and thinking. Onset occurs at 20-25 years of age;
• Catatonic. Vivid negative symptoms with outbursts of anger, “waxy” flexibility, and freezing in one position come to the fore;
• Undifferentiated. The symptoms of schizophrenia are erased, there is no clear predominance of productive or negative symptoms. Often confused with neurotic conditions;
• Post-schizophrenic depression. After the onset of the disease, a painful deterioration in mood is observed, which is combined with delusions and hallucinations;
• Simple. Represents the classic course of schizophrenia. The onset occurs in adolescence and has a slow course. Apathy, fatigue, worsening mood, emotional lability, and illogical thinking gradually increase. This form can go unnoticed for a long time, as it is often attributed to “youthful maximalism”;

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Diagnostics

Unfortunately, many patients are unaware of their illness, and getting them to undergo testing can be difficult. Often, even the patient’s relatives themselves are not aware of his illness, and strange behavior is attributed to bad character, alcohol abuse, etc.

The diagnosis of schizophrenia should be carried out by a qualified psychiatrist. But even if the patient is examined by a specialist in the field of psychiatry, there is a high probability of error in diagnosis. It has been established that two different psychiatrists will diagnose the same patient with schizophrenia only in 65% of cases.

There are also regional differences in the diagnosis of schizophrenia. For example, in the USA, psychiatrists make this diagnosis several times more often than in Europe. In the Soviet Union, the frequency of diagnosis also depended on the psychiatric school. For example, in Moscow the diagnosis of schizophrenia was made 3 times more often than in Leningrad. And even after the introduction of modern international diagnostic criteria, although this unevenness was smoothed out, it was not completely leveled out.

All this is due to the fact that schizophrenia is a complex, multifactorial disease, and its diagnosis is largely based on the subjective approach of a particular doctor. The situation is complicated by the fact that there are no instrumental or laboratory tests that could clearly confirm the presence of schizophrenia. In schizophrenia, some abnormalities in the structure of the brain may be observed, for example, an increase in the volume of the ventricles, as well as deviations in electrical signals on the ECG. However, they are not specific to schizophrenia, in other words, they can be observed in various brain diseases.

To exclude mental disorders associated with organic brain damage, as well as somatic diseases of the endocrine system, kidneys, liver, blood and cardiovascular system, if a diagnosis of schizophrenia is suspected, an examination of the body is carried out. The following methods are used for this:

• MRI,
• radiography,
• encephalography,
• Ultrasound.

It is necessary to differentiate schizophrenia from personality disorders of the eccentric cluster, depressive and bipolar disorders.

The presence of single symptoms inherent in schizophrenia is not in itself a diagnostic criterion. In addition, to make a diagnosis, it is necessary that characteristic manifestations be observed for at least a month.

Currently, in domestic medicine, the diagnostic criteria given in ICD-10 are used. According to them, to make a diagnosis, one of the following phenomena must be present within a month:

• the feeling of the sound of your own thoughts in your head or the openness of your thoughts to others,
• hallucinatory voices,
• crazy ideas.

In their absence, a diagnosis can be made if at least two signs of lesser significance are present for a month or more:

• persistent hallucinations accompanied by delusions,
• slurred or incoherent speech
• catatonic symptoms,
• negative symptoms (apathy, poor speech, decreased emotionality or inadequate expression of emotions),
• loss of vital interests (for a year or more).

If these phenomena are observed for less than a month, acute schizophrenia-like disorder is diagnosed.

Conversation with the patient and loved ones

The main diagnostic method remains examination of the patient. To make a diagnosis, the doctor must talk with the patient, and he must answer the questions asked of him. No doctor would risk making a diagnosis in absentia without seeing the suspected patient. Unfortunately, the patient is not always aware of the fact of his mental illness. It can be difficult for a patient's family to persuade him to see a doctor. This makes timely diagnosis difficult, and as a result, therapy begins only when the last stage of the disease occurs.

A conversation with the patient’s relatives is also important, as they can point out to the doctor the manifestations of the disease that the patient himself may not notice.

How to treat schizophrenia in men

Treatment of schizophrenia is a complex and lengthy process. Despite the fact that there is an opinion that the disease is incurable, a significant number of patients, after a properly selected course of treatment, return to normal life, and some patients are completely cured. Thus, the diagnosis is not a death sentence for the patient. The main thing is to start therapy at the first evidence of the disease. On the other hand, it is naive to hope that the disease can go away on its own, like the flu. Careful and professional treatment is required.

The prognosis is more favorable in the following cases:

• if productive symptoms prevail over negative ones;
• if the patient initially has a high level of intelligence and education;
• if the family actively supports the patient in his quest for recovery;
• when the disease manifests itself at a late age;
• in the absence of serious somatic diseases, alcohol and drug addiction;
• if treatment was started in a timely manner.

Schizophrenia is often accompanied by depression and anxiety disorders, drug and alcohol addiction, which also require treatment.

Therapy usually consists of several stages:

• the first stage – relief of acute manifestations of the disease;
• the second stage is the socialization of a person, his adaptation to life in society;
• the third stage is maintenance therapy, prevention of exacerbations.

Treatment of schizophrenia is usually carried out on an outpatient basis, indications for hospitalization are aggressive behavior, episodes of delirium and hallucinations. In some cases, if the patient’s condition is moderate, but daily procedures are required, it would be optimal to treat the patient in a day hospital. This form of treatment is preferable, since the patient does not lose family support. If the patient behaves violently and poses a serious danger to others and himself, he must be forcibly hospitalized.

In case of frequent exacerbations, it is necessary to undergo examination by a local psychiatrist 3 times a month; in case of remissions, this procedure is carried out once every six months.

Treatment methods for schizophrenia:

• psychotherapy (cognitive-behavioral, group, family, psychoanalysis),
• drug treatment,
• electroconvulsive therapy (for catatonic agitation),
• insulin or atropine coma.

Alternative psychotherapeutic methods such as occupational therapy, music therapy and art therapy have become widespread.

Proper nutrition is also important, since a diseased brain must receive sufficient nutrients.

Insulin coma is a treatment method in which the patient is immersed in an artificial coma caused by the introduction of a certain dose of insulin. Over time, the insulin dosage increases. A total of 15-20 sessions are required. Treatment with insulin coma has many contraindications. In Russian psychiatry, the method is widespread, although in Western medicine the method is considered dangerous and ineffective, and for this reason is not used.

In electroconvulsive therapy, a patient is induced to have a seizure using an electrical current. This method is effective for catatonia resistant to muscle relaxants. The effect of the current lasts 0.2-0.4 s. A total of 5-7 sessions are performed (every other day).

Drug therapy

Medicines used in therapy:

• neuroleptics (aminazine, amisulpride, olanzapine, risperidone, clozapine, haloperidol, thioridazine),
• antidepressants,
• mood stabilizers,
• tranquilizers,
• muscle relaxants,
• nootropics (phenibut, Cerebrolysin, piracetam), vitamins and microelements to improve the functioning of the nervous system.

The main class of drugs for the treatment of schizophrenia are antipsychotics (neuroleptics). They are able to relieve both negative and positive symptoms. When combating negative symptoms, atypical antipsychotics (clozapine, risperidone, amisulpride, olanzapine) demonstrate the greatest effectiveness.

The mechanism of action of antipsychotics is based on stabilizing the level of dopamine in neural circuits. The maximum therapeutic effect develops after 7-14 days. A good response to drug therapy is observed in 50% of patients, a partial response in 25% of patients. Every fourth patient has resistance to first-line antipsychotics. In such cases, patients may be prescribed clozapine, an antipsychotic with high effectiveness, but with an increased level of side effects.

Psychotherapy

The goal of psychotherapy is not only to treat the patient, but also to increase the level of his social activity and return him to a full life. Cognitive behavioral therapy has demonstrated the greatest effectiveness. Although psychotherapy is not as effective in relieving delusions and hallucinations as traditional antipsychotic therapy, cognitive behavioral therapy can reduce the level of suffering of patients and correct the most deviant forms of their behavior.

Family psychotherapy

Family therapy is an integral part of the treatment process. The doctor must tell the patient’s relatives and friends about what the disease is, how to react to the patient’s behavior, how to behave with the patient, what kind of help and support he should receive. It is no secret that the frequent reaction of others to a mentally ill person in the family is fear, contempt, and rejection. Especially if the patient shows aggressiveness, he is unpredictable in his behavior, and is sloppy. Phenomena such as delusions and hallucinations can be treated with medications. However, the treatment of the disease is long-term, and the patient needs psychological support, not rejection. After all, a schizophrenic is not to blame for his illness.

What treatment methods are used in which cases?

At the onset of the disease, psychotherapy sessions are usually preferred. For persistent productive symptoms (hallucinations, delusions), antipsychotics are used. These are first line drugs. Both old, proven drugs, such as aminazine, and atypical antipsychotics (risperidone) can be prescribed. For catatonic agitation, tranquilizers are used, and for catatonic stupor, muscle relaxants are used. Tranquilizers (diazepam, chlordiazepoxide, phenazepam) help reduce anxiety, normalize sleep, and have a muscle relaxant effect. Antidepressants (sertraline, fluoxetine) are prescribed for disease-associated depression. Normotimics (carbamazepine, lithium salts) are used for catatonic and manic agitation, to correct the patient’s behavior.

How is schizophrenia treated?

It has been proven that therapy is more effective in the absence of psycho-emotional stress. For this purpose, it is necessary to involve the patient’s relatives in the treatment process. To do this, relatives must know and understand the main aspects of the disease.

Most often, exacerbations occur as a result of the patient’s refusal to take medications. Family members should understand once and for all that strict control over the use of medications is necessary. Relatives must be able to convince, persuade, and force the patient to take the medications prescribed by the doctor.

Also, many clinics have special psychotherapeutic programs for patients with schizophrenia. Their activities are also aimed at combating relapses of the disease. It would be a good idea for patients’ relatives to become familiar with these programs.

Rehabilitation

Unfortunately, some people with schizophrenia require constant isolation. However, most return to their normal lives after the symptoms of the disease are relieved. If relatives are unable to care for the patient, it is possible to place him in a special boarding school.

In these institutions, patients receive qualified psychological and medical care. They look not like a hospital, but like a dormitory. There, patients are in a favorable environment, which contributes to the rapid improvement of their condition. Employees regularly monitor medication intake. These institutions operate programs aimed at the social adaptation of patients.