Schizofrenie bij mannen: symptomen, karakteristieke gedragskenmerken

The first signs of schizophrenia are usually perceived by the close environment as eccentricities - bad moods, lack of emotions, isolation are not specific signs of schizophrenia alone, or of mental illness in general. Especially since the disease can develop in different forms and at different rates. If the disease manifests itself violently and is manifested by an acute psychosis, there is no doubt in the loved ones that the mental state requires correction. The patient quickly receives help, and such a development is often more favorable than a prolonged gradual increase in the manifestation of negative symptoms - increasing passivity, emotional and energy deficit. [1]

The main symptoms of psychosis in schizophrenics and other mental illnesses are perceptual deceptions or hallucinations; persistent ideas and beliefs that have no relation to reality - delusions; manic and/or depressive affective disorders; movement disorders (catatonia).

Often the first sign of the disease in men is psychomotor agitation, which manifests itself in various forms. The schizophrenia and schizophreniform syndromes are characterized by the following:

• catatonic psychomotor agitation is manifested by constant movements, rhythmic, monotonous, coordination may be disturbed, in addition, the patient speaks without ceasing - mannerisms, grimaces, mimics others, actions are characterized by impulsiveness, speech is incoherent, contains rhymes, repetition of the same words or phrases, the condition is accompanied by violent emotions - the patient may be angry, aggressive, pathetic, ecstatic, at times, outbursts of emotion are replaced by indifference;
• hebephrenic psychomotor agitation is manifested by foolish behavior and senseless impulsive actions, which in many cases are aggressive in nature;
• manic form - characterized by activity and irrepressible desire for activity, mood is elevated, actions and ideas are characterized by absurdity, inconsistency, associative thinking, there may be delusions and hallucinations;
• in psychomotor agitation against the background of hallucinations, the patient is usually focused and tense, makes impulsive impulsive movements, often of aggressive or defensive nature, speech incoherent with threatening intonations;
• In delirium, the patient is irritable and angry, characterized by mistrust, and may suddenly attack or injure himself.

But such a vivid debut does not always occur. Sometimes one of the earliest manifestations of schizophrenia is a change in the patient's character, especially if the patient has previously absent features. For example, a marked decrease in ability to work, activity, decreased interest in activities that were previously favorite; sociable man may become a homebody, stop meeting with friends, favorite girl, he may change his attitude to loved ones - wife, children, mother, he will become indifferent or even rude and irritable. At the same time, in his free time, he will become long "stuck" in one place with an absent look, just lying or sitting on the couch, obviously not doing anything, preferring any activity to loneliness. Such inactivity can concern different spheres: home activities and so-called "going out into the world - to theaters, guests, exhibitions", study or work. The intervals of isolation increase, the man stops taking care of his appearance - changing clothes, taking a shower, brushing his teeth and clearly prefers his own society.

Disorders of the thinking process in schizophrenia and schizophrenic spectrum disorders are expressed in the loss of consistency of thought activity, its purposefulness and logicality. The logical connection between thoughts disappears, they are often interrupted (sperrung); as the disease progresses, the patient is often unable to express his or her thoughts coherently, which manifests itself in the fact that the patient's speech turns into a chaotic set of unrelated fragments of phrases.

In milder cases, the patient's speech is dominated by a tendency to abstraction and symbolism, there are unusual and ridiculous associations Thoughts "slip", the patient, without noticing it, switches from one topic to another. Schizophrenic thinking disorders are manifested in word creation, "neologisms" are fancy and understandable only to the patient himself, in fruitless reasoning on abstract topics and in the loss of the ability to generalize the information received. Mentism is characterized by an uncontrollable flow of thoughts. Nevertheless, a certain logic in statements and actions, known only to the patient, is observed, and it is often the peculiar comprehension and integration of facts that gives away the schizophrenic.

Formally, the level of intelligence in patients, acquired before the disease and in the initial stages, remains preserved for a long time, however, over time cognitive functions are damaged, the ability to compare and analyze facts, to plan actions, to communicate in society is impaired, so the use of accumulated knowledge becomes more and more problematic for the patient. Almost always difficulties arise in patients when it is necessary to achieve goals and solve issues related to the need to attract new knowledge and skills.

Thinking disorders in some cases accompany only relapse periods and disappear when the condition stabilizes. Some persistent thought disorders persist during the latent period, constituting a growing cognitive deficit.

The symptomatology of schizophrenia and schizophreniform disorders is quite diverse and can be detected to varying degrees depending on the form and severity of the disease.

To raise the question of a diagnosis of schizophrenia, according to the International Classification of Diseases, the patient must have at least one so-called "major" symptom or two "minor" symptoms.

One of the following manifestations will suffice:

• the patient's confidence that his or her thoughts are completely open to being read, that they can be stolen, erased or, conversely, "put" into the head from outside (thought echo);
• the patient's belief that he or she is being controlled from the outside, clearly correlated with actions, movements, thoughts, and sensations (delusions of influence and delusional perception);
• auditory hallucinations - one voice or several voices coming from different parts of the body commenting on the patient's actions, giving instructions or simply communicating;
• the presence of delusional ideas that go against the generally accepted beliefs and rules of behavior in a given society.

Either at least two "minor" symptoms in any combination must be present:

• persistent supratentorial ideas or any hallucinations - visual images and whole stories, touches, smells, combined with the regular occurrence of often not fully formed delusions, without a pronounced affective component;
• Sperrung and mentism, confusion and impoverishment of speech, and/or neologisms;
• catatonia, its individual manifestations and other motor disorders;
• thinking disorders - inability to make logical inferences, generalize, focus on a single thought;
• apatoabolic syndrome, impoverishment of emotions, their inadequacy;
• gradual loss of interest in the outside world and social ties, increasing passivity and isolation.

Psychotic schizophreniform symptomatology should be observed for at least one month with a prolonged (at least six months) decline in basic human functions related to work, family relationships, and friendships.

New disorders acquired in the course of the disease (delusions, hallucinations, supervalue ideas) are called productive or positive, emphasizing their addition to the pre-disease state of the psyche. Autism spectrum disorders, depletion of emotions and energy levels are referred to as losses or negative symptoms.

The behavior of a man with schizophrenia

Before the onset of obvious symptoms of schizophreniform disorder, some oddities may be observed in a man's behavior - commitment to loneliness, isolation, excessive preoccupation with certain activities that seem useless to others, long fruitless discussions on selected topics, neglect of appearance, work, study. Nevertheless, as long as these manifestations do not have the severity of schizophrenic spectrum disorder, no one can predict its development only by their presence, much less prescribe preventive treatment. Some oddities are inherent in many people who will never get schizophrenia. Such a diagnosis is made according to fairly specific criteria.

However, the success of treatment depends largely on its timely initiation. The behavior of a man with schizophrenia differs from the generally accepted norms even outside of psychosis. Productive symptomatology has a great impact on the patient's worldview and, accordingly, behavioral deviations become noticeable. [2]

In the presence of hallucinations, usually auditory, you may notice that your relative often dialogues with an invisible interlocutor, as if answering questions or commenting on something, often suddenly falling silent and listening. At times you may hear laughing, crying or angry shouts. The hallucinating patient usually has a concerned or anxious facial expression that does not match the current situation. He or she has difficulty concentrating on a particular task or topic of conversation, as if something is distracting him or her. In short, it seems that the patient hears (sees, feels) something inaccessible to others. Specialists advise not to laugh at the patient in any case and clearly not to be frightened by what is happening. It is also not recommended to dissuade the patient in the illusory nature of his sensations and ask him in detail about their content. Nevertheless, it is possible to let him speak if he wants to, and try to persuade him to see a doctor. But it is necessary to act as gently as possible, trying not to hurt the feelings of the patient. Many of them realize the unreality of what is happening at the initial stage, and timely support can help to start treatment.

Aggression in schizophrenia in men is most often a manifestation of delusional disorder. With delirium, the patient becomes suspicious, clearly traced his distrustful attitude, most often to the closest people. Sometimes, delusions of exposure concerns the life or health of loved ones, then the patient surrounds them with prohibitions and hypertrophic care. Unwillingness to obey the requirements causes aggression in a schizophrenic, in general, any opposition to the patient can cause inadequate anger. The appearance of delirium may be indicated by a sudden unfounded suspicion or hostility, often toward close or good acquaintances, sometimes toward complete strangers, visible manifestations of fear - careful locking of windows and doors, pulling the curtains on the windows, cutting additional locks, checking food for poisoning and other protective actions. The patient may claim that they are being stalked, threatened with kidnapping themselves or loved ones, read their thoughts or irradiated with invisible rays. The persecutors may be from the realm of science fiction - aliens or agents of foreign intelligence. He may develop beliefs in his own great mission. But sometimes the fictional stories are quite realistic - adultery, intrigues of competitors, complaints about noisy neighbors, their children who damage, spoil property, negligent employees who interfere with the implementation of a project, and so on.

Often the man begins to show carelessness in clothing, neglect hygiene. The emotional component is lost, usually the patient cannot empathize with real suffering, however, he does not stop expressing emotions, he can laugh and cry, completely inappropriately, inappropriately, in inconsistency with the situation, and some of his thoughts and experiences. The look of patients becomes inexpressive, turned inward, they are characterized by strange, in the eyes of others, statements, inadequate reactions. Schizophrenics absolutely do not tolerate criticism of their views, behavior, supervaluable ideas and beliefs. No logical inferences can change the patient's mind about his or her morbid fantasies.

A sudden manic fascination with occult sciences, religion, esotericism, accompanied by an increasing detachment from reality, is also characteristic of schizophreniform disorders.

Motor functions change. In some patients in the prodromal stage suddenly appears slowness, everything is done with arrangement, accents, for example, in a certain order arrange things in the apartment or on the table. Hands or legs may begin to tremble from tension. Unusual motor activity - suddenly appeared fidgeting, more intense facial expressions can also precede the debut of the disease. Schizophrenics are characterized by strange fanciful speech, inconsistent, with repetitions, accents, and word-making.

The behavior of a man with schizophrenia is not consistent with the current situation, nor with life experience, and often with socially accepted standards of behavior. He lives in his own personal illusory world. In most cases, absolutely senseless, from the position of a normal person, the schizophrenic considers the only right thing to do, and it makes no sense to change his mind. Also, many patients do not recognize themselves as such and do not want to seek help, seeing in the persuasion of the intrigues of ill-wishers. Schizophrenics, despite the apparent amorphousness, are extremely sensitive even to minor events, remarks, various trifles relating to their fantasies and beliefs. In general, people with a sick psyche are usually selfish, they are concerned only with their own problems, appearing in a far-fetched world. Relatives are advised to act carefully, not to pressure the patient, not to argue with him, because coercion can cause aggression.

Once treatment is started, most patients become sane quite quickly. But without treatment, the so-called negative symptomatology takes its turn. Increasing isolation in their experiences, anxiety, disassociation from the outside world dulls emotions, as there is not enough external information to produce them. This is accompanied by abulia - loss of volitional impulses and motivation for the most basic actions, and apathy. [3]

Signs of mild schizophrenia in men

As noted above, the manifestation of the disease in the form of a vivid psychosis leaves no doubt that the patient needs the help of a psychiatrist. It is much more difficult to recognize the gradual development of the disease or its mild forms. Sluggish schizophrenia often manifests at a young age, and its first signs coincide with the pubertal crisis. At this time, all young people are inherent in the search for meaning in life, the desire for independence and the associated rejection of authority, fascination with various philosophical teachings. Teenagers are rude and irritable, often trying to express themselves, extravagant or deliberately sloppy dressing, shirking household chores and "run" studies, so the initial stage of the disease may well not notice even the closest people. [4]

But, if you try hard enough, you can pay attention to some signs. In schizophrenia, mutual connections between individual personality characteristics are lost, while intelligence, memory and skills are fully intact, especially in the mild course of the disease. It can be seen that the feelings and emotions of the patient, from the point of view of a healthy person, do not correspond to external stimuli, the current situation or subjective interests, the same happens with thinking and other types of brain activity. All functions are preserved - the person thinks, speaks, listens, gets angry, laughs or cries, however, the mutual correspondence of these actions is difficult to catch from the outside.

In mild cases, the patient is diagnosed with schizotypal disorder (formerly called sluggish schizophrenia). The patient has oddities in behavior, eccentricity and eccentricity, pretentiousness of speech, pompousness and pithiness with poverty and inadequacy of intonation, and mannerisms. In general, the same schizophreniform symptomatology described above is observed, only in more subdued forms.

For the early stages, the symptomatology of neurosis prevails. The patient often complains of sleep disturbance, intrusive thoughts, wisecracking, "mental gum", distorted perception of reality, abstract obsessions. The specificity of obsessive components in the beginning will distinguish not even every experienced psychiatrist. In schizotypal disorder, they are little understood, characterized by a spontaneous nature and the rapid development of persistent extremely bizarre rituals. Phobias in patients with schizotypal disorder also quickly become habitual. Talking about them, patients do not express any emotion. The fears are absurd - patients are afraid to see, for example, objects of a certain shape or color, to hear any words spoken necessarily by a child, and so on. Sometimes in the beginning it is possible to establish a connection between the phobia and a psychotraumatic event, but with time its plot becomes more complicated and the origin of the fear is erased.

The patient "grows" ridiculous rituals, they interfere with normal life activities and sometimes take a leading role in behavior.

In schizotypal disorder, depersonalization/derealization, in particular dysmorphophobia, occurs, and patients are embarrassed of quite normal body parts, hide them, shy to show them. If there are real disfigurements, patients ignore them. Hypochondriacal complaints are characterized by fancifulness and unreality, abstruse diets are followed, the purpose of which is also formulated not quite typical, for example, for the face to be oval rather than round.

The disease can manifest itself in different ways. Patients are "engaged in scientific labor", doing all day long, writing out of a variety of literature, useless and incoherent quotations, which are difficult to even unite a common theme; draw schemes and drawings of unclear purpose; develop projects; reason on global, but very abstract topics, stating their thoughts incomprehensibly and confusingly, say long monologues, not allowing to insert a word or ask a question. Some patients put on themselves scientific experiments - trying different toxic substances, lying in a cold bath, and so on. Such "experiments" can end in disability or even death.

In lethargic schizophrenia, frequent hysterical attacks are observed in both sexes, which are quite strong and not associated with visible stressors. Hysterical attacks are characterized by deliberate caricature and demonstrativeness, increasing negativism, unmotivated hyperexcitability. Playfulness, mannerisms, inadequate grimaces, wiggling gradually take a monotonous form, become formulaic and monotonous, there is emotional inadequacy, coldness and callousness towards close people, especially parents. Negative symptomatology develops.

Age specifics

The age at which schizophrenia debuted is associated with some, though not obligatory, peculiarities of its course and treatment prognosis - the later it is, the easier the disease is and the less destructive its consequences. The most unfavorable prognosis is characterized by hereditary congenital schizophrenia, although it is possible to diagnose a child from the age of seven. It is believed that at this age it is already possible to establish the presence of delusions and hallucinations. Specialists are trying to find criteria by which to diagnose schizophrenia in the very young. It is assumed that even infants have hallucinations and delusions. [5]

A child with schizophrenia behaves differently from his or her healthy peers. Suspect the presence of the disease in the very young can be suspected by the manifestation of irrational fear - fear of toys and / or other objects of a certain color, shape, depicting an animal or cartoon character. Babies with schizophrenia are indifferent, and sometimes even with fear of their own mother, who for a healthy child of early age is the most important key figure. The behavior of a sick child is often inexplicable - he cries, gets angry and capricious for no apparent reason, reacts inadequately to attempts to attract his attention.

At a later age, when the baby begins to enter into social contacts with other children and adults, pay attention to the manifestations of obsession, unwarranted aggression, lack of desire to play with peers, indifference to walks, swings and other favorite children's entertainment.

A child who has mastered speech can tell his parents or older children about the voices he hears, it can be noticed that he responds to them, listens to something. The development of schizophrenia in a child can be indicated by frequent gratuitous mood swings, indifference to the usual activities for children of the appropriate age, chaotic speech, inadequate reactions, endless caprices and fears. Parents who notice these behavioral features are advised to record their observations in a diary, then psychiatric consultation will be more effective.

Schizophrenia most often manifests in adolescence, especially its severe forms - simple, catatonic, hebephrenic, with both continuous and seizure-like course. In addition, adolescence is often the debut of a low-progressive form of the disease - schizotypal disorder. Adolescence is complex enough in itself and is characterized by high emotional stress, perhaps that is why the disease is most often manifested in this period. And often before the onset of the disease teenager does not cause much trouble to parents - diligently studying, characterized as serious and obligatory, his behavior does not cause complaints. Suddenly the young man become difficult to manage, rude, indifferent to the closest people. He has difficulties with learning, losing interest in previously favorite activities, but there may be new ones, to which he devotes all his free time. Previously sociable teenagers become isolated, tend to run away from home, use psychoactive substances, become slovenly, suspicious and aggressive.

Signs of schizophrenia in a man 25, 30, 40, 50 years of age have practically no age differences. In adults, the paranoid form develops most often. The development of the disease is gradual, personality changes increase over the years. Characterized by the progression of alienation, secrecy, mistrust, caused by the appearance of delusions and hallucinations. When the disease manifests itself at a later age in a person who has had time to establish himself professionally, have a family and a certain social status, the prognosis in this case is most favorable.

In old age, schizophrenia in men is rare and progresses slowly. Such cases are much more common in women. Sometimes elderly men have an exacerbation of schizophreniform psychosis, manifested in younger years, and as a result of successful treatment for a long time did not manifest itself. It is not easy to recognize that the mental illness is exactly senile schizophrenia; it can be confused with dementia, neurotic disorders, Alzheimer's disease.