Negative psychopathological symptoms in schizophrenia

Neurosis-like schizophrenia is a chronic disease with fluctuations in intensity, which is closest to schizotypal personality disorder (ICD-10 code F21.3). The clinical picture contains psychopathological manifestations similar to neurotic ones.

In foreign sources, slowly and relatively favorably developing psychoses of endogenous origin were called differently. Such schizophrenia had the following synonymous names:

• soft;
• sanatorium;
• pseudoneurotic;
• sluggish.

According to the American classifiers (DSM), the symptoms do not fully meet the criteria for classical schizophrenia. The disease is classified as borderline personality disorder, that is, character pathology.

Risk factors and causes of development

The issue of early detection of borderline violations remains open, since it is impossible to identify specific causes of development. The following risk factors dominate:

• heredity – the presence of a schizophrenia spectrum disease in close relatives;
• identified other mental disorders in relatives, including addiction syndrome (mainly from alcohol) and manic-depressive psychosis;
• spontaneous genome mutations in a particular individual;
• imbalance between the functioning of neurotransmitter systems in the brain;
• disturbance of human psychomotor development in early childhood and/or pathology of pregnancy in the mother;
• disharmonious socio-psychological conditions in which a child grows up, including orphanhood;
• male gender and young age are more questionable factors, since the development of pathology can occur at any period of life.

Most patients seek help before the age of 35, as symptoms interfere with daily life and reduce ability to work. About 65% of patients have higher education.

Vandysh M.V. About some clinical and social characteristics of patients with pseudoneurotic schizophrenia // Russian Psychiatric Journal. 2008. No. 2.

The difference between schizophrenia and neurosis

Pseudoneurotic schizophrenia refers to one of the forms of schizotypal disorder. At its core, this mental disorder is not related to schizophrenia. There are no hallucinatory-delusional symptoms and the formation of a personality defect does not occur. There is an eccentricity of character, emotional lability, an unreasonable passion for philosophy, mystical sciences and abstract theories, neglect of appearance, the formation of overvalued ideas and a decrease in life productivity.

Although the social activity of such patients remains, they rarely reach the end of their education, work inconsistently and in benign conditions, and do not strive to start a family.

Therapy for patients with neurosis-like schizophrenia consists of individual and group psychotherapeutic work and assistance in their social adaptation. Typically, psychiatrists in state psychiatric institutions can give such patients little, prescribing weak sedatives. Therefore, you need to look for a private psychiatric clinic that has specially developed therapeutic programs for psychological assistance and experience in managing this category of patients.

About the Transfiguration clinic

The Transfiguration Clinic has extensive experience in treating patients with schizophrenia and schizotypal disorder. Experts have developed a special therapeutic program to help such people. Methods of psychological assistance are actively used both for the patients themselves and for their relatives. If necessary, modern and safest medications are prescribed.

Cost of clinic services

You can learn more about the methods of treating the mental disorder you are interested in, as well as the conditions of stay, by calling in Moscow: 8(495) 632-00-65,.

Features of pseudoneurotic schizophrenia

Symptoms appear spontaneously without a clear connection with external factors. Over time, manifestations may increase or disappear on their own. The clinical picture is ambiguous, as it may correspond to other diseases. Only a psychiatrist can verify the condition.

Behavior

The intensity of manifestations varies depending on the severity of the disorder in a particular person. Despite individual differences, the behavior of patients may have the following general characteristics:

1. Obsessive (obsessive) actions of high strength. People perform their characteristic rituals for a long time, not paying attention to the people around them. For example, washing your hands three times is a prerequisite for leaving the house.
2. Removal from society is the autization of personal attitudes. The circle of communication is limited to relatives or single friends. Communication takes place more out of necessity, which does not make patients unhappy.
3. Strange manner of speech using abstract phrases.
4. Atypical style of clothing. Often simply untidy, indicating complete indifference to the opinions of other people.
5. Ignoring conventions, rules of behavior, etiquette.
6. Narrowing the range of interests.
7. Refusal to eat to the point of anorexia or bizarre dietary habits. For example, a person begins to eat only herbs or raw foods. The motivational reasons for such tricks are illogical - “I want my face to look like a cat’s face.”
8. Monotonous asthenia is a neuropsychic weakness that does not improve after rest.

Any anxiety acts as a catalyst for anxiety-phobic syndromes. It becomes difficult for a person to respond adequately in simple social situations. Any changes in psycho-emotional status are reflected in behavior.

Psycho-emotional and neurotic manifestations

Neurosis-like symptoms arise against a persistently altered psychopathological background. During periods of exacerbation the following symptoms are typical:

• daily mood swings for no reason;
• anxiety and restlessness intensify in unfamiliar conditions or crowded places;
• tendency to reflect;
• obsessive doubts and obsessions with contrasting content;
• several different emotions appear together or replace each other too quickly, and their color also changes unpredictably;
• reactions to ordinary stimuli are inconsistent or generally inert;
• feelings of guilt, anger, fear are distorted, but it is extremely difficult to cope with them;
• anhedonia – decreased ability to experience pleasure;
• pronounced insurmountable phobias of strange content, for example, fear of the color red or the letter “O”;
• sensory-emotional experiences can be perceived by a person as a manifestation of weakness, so he tries to refuse them;
• Hypochondria is an excessive concern about one’s health, which manifests itself in the form of fanciful complaints (“bones are crumbling,” “blood flows from one hand to another”).

In severe cases of the disorder, obsessive-phobic experiences reach such strength that some patients begin to show signs of suicidal behavior. The first changes can be noticed in adolescence, since obsessions usually remain the same, but their severity worsens.

FINK Gennady Fishelevich. SLUGGY NEUROSIS-LIKE SCHIZOPHRENIA (CLINICAL-SYSTEM-ANALYTICAL STUDY). Abstract of the dissertation for the degree of Doctor of Medical Sciences

Sensorimotor perception

A person’s perception of his own body changes, usually in a negative way. Among the symptoms, the following changes predominate:

• depersonalization – a violation of a person’s self-perception, in severe cases – a feeling of loss of one’s own “I”;
• dysmorphomania – a painful belief in the presence of physiological defects or deficiencies, reaching the level of delusional disorders;
• pathological belief in (imaginary) ugliness becomes a barrier to social interaction;
• alleged shortcomings and defects are masked with the help of clothing, perfume, and unjustified surgical interventions.

Sluggish schizophrenia tends to progress and transform into a more severe course. In adolescence, such individuals may suffer from eating disorders (bulimia, anorexia) due to an unreasonable disgust for their body.

Thinking

Symptoms are grouped into a single clinical picture, accompanying each other. With a more detailed diagnosis, the doctor also identifies thinking disorders:

• lack of concentration;
• a fine line between the perception of real and fictional;
• inability to hold focused thoughts for a long time;
• a person does not see the difference between thoughts that are similar in emotional color or content;
• weakening of the ability to adequately understand any concepts;
• change in self-perception;
• the constant presence of a “motivating” attitude, which triggers an unstoppable sequence of obsessive thoughts;
• the patient does not recognize antisocial behavior, so their actions often cause confusion among others.

Excessive preoccupation with one's own health or appearance is reflected in thinking, which becomes pathological. At the same time, the patient does not understand the depth of the problem.

Peculiarities

Neurosis-like schizophrenia is also called pseudoneurotic and schizoneurosis. The term was coined by scientists Paul Hoch and Philip Polatin in the 1940s. The name is due to the similarity of this pathology with neurotic disorders. For a long time this diagnosis was not made. As a rule, a disease with similar symptoms was considered as a type of sluggish or poorly progressive schizophrenia.

According to the International Classification of Diseases, 10th revision, neurosis-like schizophrenia is a subtype of schizotypal disorder and is included in category F21.3. The main symptoms are obsessions, compulsions, phobias and hypochondria. Therefore, it is often confused with OCD and other neurotic conditions. The onset of illnesses is similar. The following criteria help determine the diagnosis:

• Neurosis occurs after a strong emotional shock, and schizophrenia manifests itself for no apparent reason.

• Neurotics understand that they are sick, and therefore want to get rid of the symptoms that prevent them from living fully. Schizophrenics deny that they have the disease. As a rule, they are brought to the clinic by relatives.
• Neurosis does not cause personality disintegration. After healing, a person becomes the same as he always was. Schizophrenia leaves an indelible mark, although not always serious, on the personal qualities of an individual and affects his “I”.
• Neurosis can be cured completely. Schizoneurosis responds well to treatment, but the diagnosis remains for life. The risk of relapse is quite high.

The main difference between the pseudoneurotic form of schizophrenia and its other types is the ease of its course. Its symptoms are not as intense as, for example, with paranoid disorder. This means that a person with a similar diagnosis, with a favorable outcome (the probability of which is quite high), can lead a decent lifestyle.

Diagnostics

Due to the similarity of symptoms of neurosis and neurosis-like schizophrenia , which manifests itself at an early stage of development, difficulties arise in the timely diagnosis of the disease and its differentiation. However, an experienced psychiatrist knows what signs to use to identify pseudoneurotic schizophrenia.

• The development of neurosis is necessarily due to some serious reason . A person, on his own initiative, turns to specialists, wanting to overcome his difficult psychological condition. All changes that occurred to him during neurosis are reversible and do not affect the deformation of his personality.
• The development of schizophrenia can be triggered by various factors , such as negative hereditary predisposition, traumatic brain injury, psychological trauma, physical and sexual abuse. There is no single reason. The patient does not see anything strange in his behavior. The initiative to contact a psychiatrist, in most cases, belongs to his relatives. Some changes may be irreversible and affect the deformation of a person’s personality and behavior.

It is very important to diagnose this type of mental disorder in a timely manner. Despite the fact that the manifestation of negative symptoms is mild, smoothed out, the lack of treatment can lead to the progression of the disease and its transformation into more severe forms of schizophrenia - paranoid or with a manic component.

Neurosis-like schizophrenia in symptoms

In neurosis-like schizophrenia, the appearance of the first symptoms is not associated with any traumatic situations or premorbid characteristics of the body - when its defenses are noticeably weakened. The person is not aware of his illness and does not seek to visit doctors for treatment, which is why he often ends up in a psychiatric hospital. It is characteristic that the defect gradually accumulates - even with good therapy, only long-term remission is possible. It is not possible to completely get rid of the pathology.

Signs and symptoms of neurosis-like schizophrenia begin to intensify over time. They are characterized by a progressive course - when the phases of exacerbation and remission each time only increase the deterioration of the patient’s condition. In the worst case, a continuous deterioration in well-being is possible.

Causes of schizophrenia in women

There is currently no sufficient data on the causes of schizophrenia and the paths of its development, but as we have already stated earlier, a large number of specialists in psychiatry and psychoanalysis attach the main importance in its occurrence to the patient’s heredity. Also, the nature and course of the disease largely depends on the gender of the patient. The reasons for this are the cyclical nature of neuroendocrine processes associated with menstrual function, pregnancy, childbirth, but the prognosis, in general, is also considered favorable. The main causes of schizophrenia in women most often lie in childhood or adolescence - during this period, malignant forms of schizophrenia develop.

Forecasts

The disease has a favorable treatment prognosis. Most patients achieve a state of stable remission, which can last for years. Thanks to pharmacotherapy and psychotherapy, the patient gets rid of phobias, restores, as far as possible, mental functions, volitional and emotional spheres, establishes social connections, returns to society and the family. However, to prevent relapses and relapses, it is necessary to continue taking the medications and follow all the recommendations of the attending physician.