Continuously progressive (paranoid) schizophrenia. Variants of the course of different forms of schizophrenia

The doctor’s determination of the nature and type of course of the disease - vertebral and vertebrogenic pathology (more precisely - neurological manifestations osteochondrosis of the spine) - is not a “tribute to academicism” and not “clinical pedantry”, but is the “criterion” that in turn determines specific therapeutic and preventive (including medical and social) measures over time (the course of the disease is clinical characteristics, reflecting the characteristics and manifestations of the disease over time.). I will leave this statement without explanation, since the latter would look like an excuse - an explanation of an obvious truth, and it cannot look otherwise. An introduction taken before the presentation, which will narrate, as indicated, the obvious and in highest degree necessary within the framework of not only vertebrology (vertebroneurology), but within the framework clinical medicine“in general” is the first step, declaring an upcoming important “reminder” (for those who knew, but partially forgot - reminiscence), or “learning” (for those who did not know, but feel such a need - actualization). And so, let's consider possible options“course” of vertebral and vertebrogenic pathology (neurological manifestations of spinal osteochondrosis). But in order to accomplish the latter, it is necessary to explain the periods of illness, their duration and severity, which actually determine the nature and type of course.

Periods of illness- these are stages in the course of the disease, differing in a certain clinic, severity, duration and sequence of development. The periods are: debut, exacerbation, relative stabilization, remission, residual period.

Debut– the period of the first clinical manifestations, characterized by a certain phase (see below) and a duration of no more than 3 months

Exacerbation- a period of illness characterized by (the development of the most severe symptoms within a period of up to 3 weeks) or the development of clinical manifestations of any severity after a period of complete remission or an increase in manifestations by one or more degrees after a period of incomplete remission (see below) or relative stabilization. Exacerbation is also characterized by typical phasicity. Exacerbations are distinguished not only by severity, but also by frequency: more than three times a year - frequent, 2-3 times a year average, up to once a year rare. In addition, the duration of the exacerbation is noted: up to one month - short-term, more than a month - long-term.

Phases a characteristic sign of debut and exacerbation. They replace each other in a certain sequence. The initial phase is established from the moment the symptoms appear or intensify within one degree of severity. It is followed by an increasing phase - an increase in severity by more than one degree. After the rising phase comes stationary phase , during which the maximum degree of manifestations is noted. In most cases, the stationary phase passes into a regression phase, during which the severity of clinical manifestations decreases with the transition to a period of complete or incomplete remission (see below).

Remission- this is the period between exacerbations with the severity of the disease from 0 to 2 degrees. Accordingly, complete remission is distinguished (grade 0), incomplete type A (grade 1) and incomplete type B (grade 2).

Relative stabilization represents a period of illness, which is characterized by manifestations of the 3rd - 5th degree in the absence of dynamics 3 months after the debut or exacerbation. Thus (taking into account the above), both “debut” and “exacerbation” go into a period of “relative stabilization” if within 3 months 1. [at debut] remission is not achieved or 2. [pre-exacerbation] is not achieved: 2.1 . remission or 2.2. incomplete remission, or 2.3. period of stabilization (that is, the stabilization that was present before the exacerbation has not been achieved, and which had a severity of symptoms of at least 3 degrees inclusive [see definition of remission] and no more than 4 degrees [see definition of relative stabilization]).

Residual period is stated in the absence of clinical manifestations of the disease (which disrupt adaptive activity) for 15 - 20 years upon reaching the age of 50 - 55 years.

Depending on the alternation of periods of illness, their duration and severity, the nature and type of course is determined.

Character of the current The disease can be recurrent, chronically recurrent and chronic. The relapsing course is an alternation of periods of exacerbation and complete remission; chronically relapsing- alternating periods of exacerbation and incomplete remission or relative stabilization. Chronically relapsing course can be primary or secondary. The latter is stated if it replaces a relapsing course. The chronic course of neurological manifestations of spinal osteochondrosis means the presence of constant clinical manifestations with fluctuations within the same degree of severity. It is stated no earlier than six months after debut ( primary chronic) or after an exacerbation in the absence of a tendency to regression ( secondary chronic). It should be remembered that primarily chronic course little typical for neurological manifestations of spinal osteochondrosis.

Type The course reflects the development of the “quantity” of the disease over time. The regressive course is characterized by a decrease in the severity of the disease over time: a decrease in the number of exacerbations, their duration and severity, dynamics from polysyndromic to monosyndromic, a change from incomplete remissions to complete ones with a tendency towards clinical recovery. Non-progressive(stationary?) course is distinguished by approximately the same qualitative and quantitative characteristics of the manifestations of the disease over the foreseeable period of time. The progressive course is characterized by an increase in the manifestations of the disease over time: an increase in the frequency and duration of exacerbations, the emergence of new syndromes, the change from complete remissions to incomplete ones, or the development of a period of relative stabilization after an exacerbation.

source: based on materials methodological recommendations for doctors: “Diagnosis of neurological manifestations of spinal osteochondrosis and its adaptation to ICD-10” Novokuznetsk, 2004

© Laesus De Liro

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Symptoms of drug addiction

Children with congenital drug addiction They are always born very weak, with low weight, whiny, capricious, with sleep disorders. They can be calmed down only after the drug addict mother, having taken another dose of the drug, breastfeeds the baby.
Children's drug addiction is much less common than childhood alcoholism, since children are rarely offered drugs, unlike alcohol. Typically, drugs are distributed among teenagers, since they are more able to pay than young children.
Manifestations of drug addiction in adolescents may be as follows:
- Sudden changes moods during the day: from depressed and/or aggressive to cheerful, joyful, energetic, maybe even falling in love. Moreover, changes in mood are not associated with any events.
-Disturbance of sleep and normal rhythm of wakefulness and rest. During the day the child is lethargic and sleepy, and in the evening, returning from a walk, on the contrary, he is cheerful and full of energy. It is difficult for him to sleep, and in the morning he cannot get up. Moreover, this happens exactly when he returns home from a walk or party.
-Changes in eating habits and appetite develop. The teenager has no appetite all day, but after returning from a walk, he pounces on food, eats an unnatural amount and is very greedy. This state is typical when recovering from drug intoxication.
- Suddenly the teenager loses interest in studies, school, or hobbies, which he had, some interests, knowledge and life in the family. They don't care at all what happens at home and at school. But there is a passion for heavy music, which in good condition difficult to perceive. It helps them to escape from constant thoughts about drugs or, conversely, helps them achieve a certain state during drug intoxication.
- Retardation in question-answer conversation. It takes an unnaturally long time for a child to answer a question. Sometimes it can get ridiculous when the question “What is your name?” comes first: “Me?” A delay may not always be a pause. A teenager may start talking about nothing, around and around, until he comprehends the question itself.
-Aggression develops. Especially in response to parental bans on walks. Aggression can be severe. Also, the child begins to show interest in subcultures, since with their help he can express his opposition to society, because he already feels outside of it.
-The child begins to speak in a peculiar slang. They need slang not for self-expression, but to hide and encrypt communication. So that no one understands what we are talking about.
- Those who use injection drugs will always wear long sleeves and/or long pants to hide the injection sites. Those who smoke marijuana will always emit a specific smell. Especially after he smoked the drug. Also, when smoking anasha, a peculiar redness of the nose and cheeks appears in the form of a butterfly.
- The change in pupils is very indicative. In a state of drug intoxication, they are either greatly narrowed, or, conversely, greatly expanded and react very slowly to light.
- And finally, the children begin steal from home and from people things, to sell them and use the proceeds to buy another dose of the drug. Gradually, personality degradation occurs.

Diagnosis of drug addiction

-Chromatography- determination of the presence of drug breakdown products in biological fluid.
- Linked immunosorbent assay - precise definition the presence of quantitative and qualitative composition of certain narcotic substances or their breakdown products or antibodies to them in the blood.
- Chromatospectrometry- determination of the presence of drug breakdown products in urine. The method is similar to a pregnancy test.
- The method is widely used abroad immunochromatographic examination of blood serum, allowing the determination of antibodies to drugs.

Drug addiction treatment

Unfortunately, there are no 100% cures for drug addiction. The longer the child used drugs, the heavier they were, the more difficult the treatment. Treatment for addiction to hard drugs is usually unsuccessful, and even if successful positive result, breakdowns and relapses occur very often. Treatment includes drug and psychological therapy aimed at relieving withdrawal symptoms, developing aversion to the drug and fixing this aversion. In the treatment of drug addiction, the desire of the patient himself to get rid of addiction is very important. After treatment, a period of social rehabilitation is required.

Drug addiction prevention

Take care of your children and don't use drugs yourself. Be aware of your child's surroundings. Conduct educational programs about the dangers of drugs.

This form of progression in childhood and adolescence has not been sufficiently studied. M.I. Moiseeva (1969) found that schizophrenia with delusional manifestations in childhood and adolescence, as in adults, can have a continuously progressive course.

The onset of the disease is gradual, expressed in increased emotional disorders■(emotional coldness, weakening of contacts and interests), mental rigidity. In preschool and junior" school age ideas of attitude predominate, "which are expressed in persistent suspicion and distrust, a "delusional mood", which, however, does not acquire a complete verbal form. Patients claim that children treat them badly, "walk in a crowd, conspire to beat", "not with who cannot be friends, they will take notebooks, books,” etc. Often already in preschool age a “delusional mood” arises in relation to the parents, towards whom the child shows hostility and distrust. Gradually, a tendency to expand delusions and involve new people in the sphere of delusional constructions is revealed. Subsequently, individual auditory hallucinations, episodic rudimentary mental automatisms, and even later, rudimentary auditory pseudohallucinations appear.

In childhood, as well as in adults, two variants of paranoid schizophrenia can be distinguished - with a predominance of delusional or hallucinatory disorders. In the delusional version initial stage delusional fantasies of a paranoid nature are noted in the form of special games and interests of a cognitive nature. In the hallucinatory variant, the initial stage is determined by excessive figurative fantasy with a pseudohallucinatory component. In cases of the delusional variant, the disease may begin at an early age (2-4 years) and progress slowly. Children often exhibit premature intellectual development - by the age of 2 they have a large vocabulary, and by the age of 3-4 they can sometimes read. Stable one-sided interests of an overvalued nature are revealed early. Initially, this manifests itself in the desire to ask special (“inquisitive”, “philosophical”) questions, in stereotypical games with schematization of game objects (selection of teapots, shoes, etc.), in a penchant for unusual collecting (soap, bottles, locks).

“Inquisitive”, “philosophical” questions are not random in content, they are cognitive in nature and associated with a specific idea. They differ from the “stage of questions” of a healthy child by an excessive interest in the abstract, which is not typical for this age, and, most importantly, by a close connection with stable, monotonous ideas. According to K. A. Novlyanskaya (1937), in children with schizophrenia, the period of “inquisitive questions” is delayed for a long time, which with age take on the character of extremely valuable ideas. An early manifestation of the disease is a pathology of gaming activity. From 2-3 years old, stereotypy in games is noted. For example, a child constantly plays with wires, plugs, sockets, not paying attention to toys. At the end of preschool and primary school age, maintaining an increased interest in electrical equipment, he begins to redraw electrical circuits and reviews physics and electrical engineering textbooks. Obsession with such one-sided interests is typical of paranoid states.

At school age, one-sided interests increasingly resemble paranoid states in adults: there is a desire to logically develop an isolated idea, a tendency to detail in thinking. At primary school age, elements of delusional depersonalization arise, and patients transform into images of their hobbies. Children imagine themselves as a “clockwork”, “trolleybus” and behave according to their experiences. Criticism of one's behavior is impaired. As the disease worsens, fragmentary ideas of persecution, poisoning, and, in some cases, ideas of greatness arise. As the progression of the disease increases, more defined delusional ideas develop

persecution and influence. Just like the delusional version of paranoid schizophrenia in adults, perceptual disorders are rarely observed. Some patients experience rudimentary auditory hallucinations.

In the hallucinatory (or hallucinatory-delusional) variant of paranoid schizophrenia, a violation of sensory cognition predominates from the very beginning, and excessive figurative fantasy takes the leading place in the clinical picture. As mental automatisms increase, fantasies become more and more pronounced involuntariness, visual pseudohallucinations and dream experiences are added. The development of mental automatisms ends with the appearance of delirium:! mastery, depersoyalization-> tion, i.e. the formation of the syndrome;) Kandinsky-Clerambault. Pathological fantasies and mental automatisms are figurative in nature (visual: pseudohallucinations, dream experiences, figurative delusions). The onset of the disease most often occurs before school age. Excessive imaginative fantasizing very early begins to be accompanied by visualization of ideas, pseudohallucinations with a feeling of influence. A certain sequence of occurrence of these phenomena in the same patient is characteristic. Thus, at the beginning of the disease, the leading ones in the clinical picture are excessive figurative fantasies with visualization of ideas; later, especially during an exacerbation of the disease during the second age crisis (6-7 years), dreamlike experiences, visual pseudohallucinations, violent thinking arise, and, finally, in school age - delusional disorders (often simultaneously with pseudohallucinations, which carry the experience of influence). Over time, delusional ideas expand, delusions of relationship, persecution, and delusional depersonalization arise (“two people live in the head” - the child sees them). In other patients, more late stage diseases, rudimentary paraphrenic disorders arise. At the same time, fantastic statements acquire the character of greatness (“I will become a god, a king,” etc.). These ideas become persistent, criticism disappears, behavior begins to correspond to painful experiences. Just as at the initial stage, during the development of figurative fantasies, and subsequently, during the development of delusional experiences, delusional depersonalization and paraphrenic disorders, all of these disorders are not so much of an ideational nature as of the nature of figurative ideas. “With the advent of delusional ideas, the process becomes more progressive.

Continuously progressive, paranoid schizophrenia in adolescents has its own

vegetable clinical features. Ideas of relationship are usually combined with dysmorphophobic delusional ideas, ideas of persecution, influence. In some cases, one can note a tendency towards systematization of delusions: patients try to logically substantiate delusional ideas. Puberty is characterized by the formation of a peculiar delusional worldview of antagonism, hostility towards people in general: “you can’t trust people, don’t expect good things”, “the kids will let you down”, etc. Antipathy often arises towards close people, especially the mother. Teenagers become angry and aggressive towards their parents, and often try to leave their parents' home. Others, with the emergence of delusional ideas, become more withdrawn, completely withdraw from the children's group, avoid people, do not go out into the street, and cover the windows. As the disease progresses, delusional ideas of poisoning and exposure arise. Closely related to delusions of influence are the phenomena of ideational, motor and sensory automatisms. Patients say that thoughts come against their will, they feel their influx, begin to mentally “respond” to their thoughts, complain that all their actions and movements cease to depend on them, that now they are “like an automaton” *, with their “language , someone else says with his lips.”

The most common plot of delusions in adolescents is the idea of physical deformity (dysmorphophobia). With a continuous progressive course, dysmorphophobia becomes an integral part of the delusional hypochondriacal system (P. V. Morozov, 1977). The content of patients' experiences is often pretentious and absurd. Patients are convinced that their calves are too thick and they cannot retain intestinal gases. Teenagers look for the causes of their defects, actively strive to eliminate them, seeking operations, sometimes “operating” on themselves. They often experience various painful sensations in those parts of the body that they consider ugly. At later stages of the disease, after 10-15 years, systematized hypochondriacal delusions usually develop with the conviction of the presence of a severe somatic illness, obsession and logical development of the delusional system. A paranoid or hallucinatory-paranoid state occurs with Kandinsky-Clerambe syndrome and the dominance of hypochondriacal ideas.

In general, continuously progressive paranoid schizophrenia in childhood and adolescence is characterized by the absence of a tendency to spontaneous remissions, a gradual expansion of delusional and hallucinatory disorders, the addition of mental automatisms, as well as an increase in negative manifestations - emotional coldness, mental rigidity, a drop in productivity, and loss of previous interests.

Malignant current schizophrenia in children and adolescents manifests itself, as a rule, either during the first age crisis (2-4 years) or at puberty. The clinical patterns of malignant schizophrenia include: 1) the onset of the disease with negative symptoms;

2) progressive course; 3) polymorphism of productive symptoms when they are amorphous; 4) high resistance to therapy; 5) a tendency to the formation of severe final states (R. A. Nadzharov, 1905; M. Ya. Tsutsulkovskaya, 1968; Yu. I. Polishchuk, 1965; T. A. Druzhpshsha, 1970).

In children of early age, malignant schizophrenia was first described by G. II. Simeon (1948), later it was studied by L. Ya. Zhsalova (19(57), I. L. Kozlova (1967, 1976) etc. Comparative learning of malignant juvenile schizophrenia and malignant schizophrenia in young children reveals general patterns, noted above. Cases of malignant schizophrenia in children early age constitute approximately 4 times the number of patients with schizophrenia of this age. The initial period is short (from 1 year to 17 years), characterized by a predominance of negative symptoms in the form of a rapid decline in mental activity, motivation, suspension mental development. Often 1 these children, even before the manifestation of the disease, from the end of the first or at the beginning of the second year of life, changes in behavior are noted - weak interest in games, a passive reaction to affection, lack of desire to communicate. Mental development - from 1 to 17 years of age can occur in a relatively timely manner. Children begin to walk on time, their first words sometimes appear before the age of 1 year, and by the age of two they have a large passive vocabulary. The disease often begins at the age of about 2 years (earlier than with sluggish schizophrenia). Children, having a large vocabulary, either stop using them altogether, or utter peculiarly constructed phrases consisting of 2-3 words and having an impersonal form (“give me a drink”, “go for a walk”, etc.). They disappear attachment, children react weakly to the departure and arrival of the mother, become unaffected. Noticeable is marked passivity, lethargy, lack of desire to play with peers, and lack of interest in toys. An early tendency to play monotonous games of the nature of motor stereotypies (threading a rope in a child’s room) appears. car, waving the same toy, tapping on a box, toy, etc.).

Despite the severity of negative symptoms (emotional changes, autism, passivity), as well as a slowdown in the rate of mental development, the latest web development

should. Children slowly acquire new words, their phrasal speech begins to form. With little interest in the environment, the child may show some emotional vulnerability* and give a painful reaction to being placed in a nursery or to a change in environment. At the age of 242-3 years, the progression of the disease increases: contact with others is sharply disrupted,

the child stops answering questions and reacting to separation from parents, previously favorite games become more monotonous and poorer in content. Gradually, rudimentary productive disorders appear: episodes of fear and, possibly, visual hallucinations (the child, pointing to the corner, asks in fear: “Who’s there?”). Catatonic and hebephrenic manifestations quickly occur.

Depending on the predominance of one or the other, two variants of malignant schizophrenia in young children can be distinguished: 1) a variant with a predominance of catatonic disorders; 2) a variant in which hebephrenic manifestations come to the fore. The first option is much more common. In this case, mutism, echolalia, verbigeration, motor retardation, short-term freezing, mannerisms, pretentious movements, anxiety, impulsiveness, aimless running in circles (“manege running”), monotonous jumping, stereotypical movements, and inadequate laughter gradually appear. Symptoms of motor excitement prevail over stuporous phenomena. In the department, the behavior of these children is extremely monotonous. They are always aloof from the children's group, do not strive for contact with the staff, and do not respond to affection. Their attention is attracted only by a short time. Children do not demonstrate neatness skills and are hand-fed. Speech is relatively intact; regardless of the situation, the child can spontaneously repeat individual phrases. In unique games, the ability for complex and subtle actions is often revealed. Unlike mentally retarded children and patients with organic dementia, they exhibit the ability to perform complex actions, a peculiar desire to systematize objects by shape, color, etc.

In the second option (with a predominance of hebephrenic disorders), at the first stage of the disease, psychopathic disorders with hebephrenic features are more often detected, and during the period of a developed disease, more pronounced hebephrenic symptoms are detected. Psychopathic-like disorders, already at the initial stage, are accompanied by changes characteristic of schizophrenia - passivity, decreased motivation, a tendency to stereotypes, pronounced negativism, opposition to any external influence, inappropriate actions, an abundance of neologisms, a peculiar desire

distort words. As the disease progresses, the phenomena of hebephrenic excitation in the form of motor restlessness with euphoria, foolishness, the desire to take unusual positions, and pronounced mannerisms become more and more pronounced. The child suddenly stands on his head, spreads his legs wide, etc. Impulsive actions are typical: aimless running, jumping, aggression. Over time, agitation, intermittent speech, stupidity, and the desire for neologisms and rhyming intensify.

A feature of the type of multiple sclerosis called primary progressive is the steady increase in deterioration starting from the moment of diagnosis. This is evidenced by the very name of the course of the disease - progressive type, that is, gradually increasing. Options for an unclear onset of an attack and its recovery are noted, as well as complete absence symptoms. Disease activity may decrease. Figures indicate 15% of cases with primary progressive types chronic disease predominantly in middle-aged and older men.

Signs of MS course type

The primary progressive type is first diagnosed at the age of 35-40 years. Both men and women are equally likely to get sick. It is noted that in people diagnosed with multiple sclerosis over 40 years of age, the disease has a steadily progressive course. However, there are a number of symptoms that differ from other types of development of this disease:

patient's age
equal distribution between both sexes
PPMS most often leads to disability before the relapsing-remitting type

Perhaps one of the most unpleasant aspects of the primary progressive type of MS is the low response to treatment. Universal effective treatment continues to be under development.

Since there are no relapses or remissions in PPMS, neurological disability has a cumulative effect over time. As with other types of MS, it is not possible to predict the level, degree and location of disorders. In the primary progressive course of MS, gradual deterioration continues to appear after the first detection.

Diagnosis of primary progressive type of MS

Most doctors come to general definitions and call multiple sclerosis one of the most complex and changeable diseases. Even such a fact as diagnosing the primary progressive type can be difficult. Only after a certain time, and visits to several doctors, as if observing and noting gradual neurological lesions without obvious outbreaks of exacerbation, one can hope for a correct diagnosis.

Symptoms of PPMS

- difficulty walking

- weakness or stiffness in the legs

- imbalances

Besides the most common symptoms there are others:

speech problems
difficulty swallowing
vision problems
rapid onset of feeling tired
bowel dysfunction
bladder problems

Root causes of PPMS:
Regardless of the type of disease, multiple sclerosis is considered an autoimmune disease. Like any other disease of this class, clinical manifestations develop due to the pathological production of autoimmune antibodies or the proliferation of autoaggressive cells, leading to destruction of normal body tissues. Common reasons Scientists around the world are studying the origin of this disease to this day. Attack of the protective sheaths of myelin in the brain and spinal cord cause disturbances in the functioning of the nervous system, creating inflammation and damage to the nerves. However, in the primary progressive course of MS, inflammation is insignificant. The same cannot be said about nerve damage. Signal interruptions in nerve endings and contribute to the emergence neurological symptoms. Plaques of scar tissue form. Actually, a scar is a dense connective formation that occurs as a result of tissue regeneration after damage. When talking about wounds on the skin, we use a more general name - scar. On the one hand, it healed well, but the whole subtlety of scar tissue lies in its reduced functional properties.

Treatment for PPMS:
Typically used to treat MS basic drugs. Unfortunately, for PPMS they are considered the least effective. This is explained quite simply. Considering that relapses and inflammation are not distinguishing factors in primary progressive MS, many doctors do not use basic drugs. These drugs only soften inflammation and reduce the number of relapses. In fact, there are no approved drugs for the treatment of primary progressive MS. So all the work is done to try to manage symptoms. They also pay attention to maintaining and maintaining a quality lifestyle for patients with MS.

Rehabilitation for this type diseases helps with:
- in speech
- swallowing
- carrying out daily activities
- diet and exercise

Proper rehabilitation, patient lifestyle and physical exercise help maintain vital tone at maximum, for a specific patient with multiple sclerosis,level.

Progressive schizophrenia has two types of course: continuous and paroxysmal. The onset of the disease, as a rule, occurs after the age of 25; in rare cases, the pathology can develop at a younger age. The disease is characterized by slow development, but in the paroxysmal form, an acute onset of the course is possible. Symptoms occur progressively, followed by personality changes.

General description of the clinical picture

The beginning of a continuous flow of a progressive form is characterized by:

obsessive ideas;
crazy ideas;
hypochondria;
psychopathic disorders.

In parallel with positive symptoms Personality changes develop such as:

anxiety;
rigidity;
isolation;
gloominess;
distrust;
withdrawal from society.

Flow options

The progressive form, in addition to a continuous and paroxysmal course, can have two more options clinical picture.

Hallucinatory variant: The symptoms are based on hallucinations. At the beginning of the disease, verbal illusions are observed. They are characterized by words spoken by someone that have nothing to do with the patient, but he perceives them in his own way, usually addressed to himself. Thus, voices seem intimidating and threatening to them, although in reality they are not. That is, there is an incorrect perception of sounds by the hearing organs. The essence of consciousness is being replaced. Verbal illusions, as a rule, arise together with a delusional interpretation; the patient perceives everything personally.

After the illusion, they are replaced by hallucinations, often auditory and monologue. When one voice constantly talks to the patient, gives him advice, orders something or scolds him. A dialogue can also be observed when several voices speak to each other in the patient’s subconscious. Often hallucinations are replaced by pseudohallucinations, in which case the emerging images become less vivid with a subjective coloring. Such hallucinations do not depend on the patient’s thoughts, they are intrusive and often have a threatening and manic character. As the disease progresses, over the years the number of heard voices increases and a picture of hallucinatory paraphrenia develops.

Continuous course is often accompanied by Kandinsky-Clerambault syndrome. The syndrome is characterized by one of the types of paranoid-hallucinatory disorders. The syndrome manifests itself as obsessive states with the idea of extraneous influence. A patient in this state believes that someone is controlling his thoughts and actions, which results in the patient’s unnatural behavior. The development of this condition occurs gradually, the condition is aggravated by fears, increased arousal, and anxiety. Against the background of the syndrome, a distinct emotional defect develops with increasing disturbance of thinking. Delusion against the background of the hallucinogenic variant also develops with the content of voices. As a rule, this is a delusion of persecution or influence.

Delusional variant of schizophrenia. Since the manifesto, there has been a predominance of distress disorders. The debut falls mainly on average age, the disease develops slowly. The course of such a transformation of the disease may have a more favorable picture or a less favorable one. In the first case, the symptoms consist only of systematic delirium of different nature, the presence of hallucinations and mental automatism is not observed. Short-term exacerbations are possible, with the appearance of elementary vocal hallucinations, fragmentary automatisms, and the appearance of an angry-intense affect. In a less favorable variant, the transition of paranoid syndrome to paranoid is diagnosed. This situation can develop systematically, as a result of expanding variations of delirium, or appear after a short period of exacerbation.

At the advanced stage, delusions of influence and persecution are clearly visible. Mental automatism becomes visible, speech is filled with neologisms, becomes abrupt and incoherent. Without a sufficient amount of psychotropic drugs, speech turns into an incoherent set of words - schizophasia. In the future, catatonic symptoms may appear; they can manifest themselves in different forms, such as catatonic excitement, substupor or stupor. In this state, a person loses generally accepted human skills, ceases to take care of himself, looks unkempt and neglects personal hygiene. Irreversible personality changes occur, and there is a sharp withdrawal from society.

Inadequacy of facial expressions, disordered thinking and paradoxical emotions are also observed. Such patients spend long time on inpatient treatment and lose their professional skills.

If the delusional variant of the continuous course of the pathology developed early, in adolescence, its course is even more malignant. This variant is characterized by early personality changes, with rapid progression of the schizophrenic defect. The features of juvenileism are clearly visible, which persist even in middle and old age.

Fur-like current

In addition to the continuously ongoing course, progressive schizophrenia has a second variant - fur-like or paroxysmal. This form, in its clinical manifestations, theoretically occupies an intermediate stage between the recurrent and continuously flowing form.

Paroxysmal schizophrenia is characterized by syndromes that manifest themselves during a continuous course, for example, paranoid, neurosis-like and paranoid. Such syndromes are combined with catatonic and effectively delusional manifestations.

As a rule, the onset of this form of the disease occurs on childhood, but often the symptoms are quite erased and can be mistaken for age-related crises, until the onset of the manifest period.

The clinical picture is expressed in the following manifestations:

mania;
depression;
catatonic disorders (excitement or, conversely, stupor);
paranoid syndrome;
a state of obsession with the appearance of phobias;
hallucinations.

The pathology can occur against the background of a depressive, manic, obsessive or psychopathic attack. Up to 25 years of age, the course of depersonalization and psychopathic attacks is characteristic. After graduation adolescence the opposite picture begins to develop, psychopathic-like disorders gradually disappear, and symptoms such as:

passivity;
mental infantilism;
emotional impoverishment.

Compared with the continuously flowing type, with a fur coat-like flow, patients adapt more easily to society and do not completely lose their ability to work. Full-blown attacks, as a rule, occur rarely; in some cases, such an episode can be observed once in a lifetime.

The frequency and quality of remission depends on many factors, for example, continuous schizophrenia has a worse prognosis and very superficial remissions, which are achieved only with the help of therapeutic effect. In the case of a paroxysmal course, remissions are observed deeper and longer. In any case, a properly selected course of treatment by a specialist is required, using nootropic and psychotropic drugs, as well as psychotherapeutic sessions.

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Continuously progressive (paranoid) schizophrenia. Variants of the course of different forms of schizophrenia

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