Schizophrenia

Schizophrenia is a progressive, lasting many years, mental illness, manifested a variety of disorders ranging from mild and transient to severe and unusually persistent, leading to partial or complete disability. Schizophrenia is the most frequent mental illness. Begins most often in the age of from 15 to 25 years, which gave occasion originally called the disease "early dementia". Often, however, schizophrenia occurs to 15 years - children and adolescent schizophrenia or after 40 and 60 years later schizophrenia. A great variety of manifestations and course of the disease allows you to select three forms of schizophrenia: 1) continuous, 2) periodic, 3) pristupoobrazna-having a progressive.

Schizophrenia [synonym: schizophrenia (schizophrenia; from the Greek. schizo - split, share, phren - mind), early dementia (dementia praecox)] - progressive mental illness, proceeding with polymorphic symptoms (neurozo - and psychopathic disorder, delusions, hallucinations, and catatonic and gebefrennyh symptoms, affective disorders and others) and leading to a special personality defect, other than defects arising at roughly organic brain damage. In schizophrenia upset highest form of mental activity, distorted reflection of the surrounding, being the most subtle individual personality traits. The degree of progression of the disease depend flaw personality and symptoms productive. Accordingly varies the level of social and labour adaptation - from adequate adaptation to its loss.
      The etiology and pathogenesis
Numerous studies of the etiology and pathogenesis of schizophrenia has not led so far to establish specific reasons and mechanisms of development of this disease.
There is a basis to assume, that in the origin and development of schizophrenic process a larger share belongs endogenous patterns of disease. Various exogenous factors may play a provocative role "trigger mechanisms".
One of endogenous factors involved in the emergence of schizophrenia, it would be heredity. Among family members of patients, the incidence of schizophrenia is much higher than among the rest of the population. There are indications that the risk of developing schizophrenia for the relatives of the patient increases with the degree of consanguinity. So, if the probability of the disease schizophrenia near foreign authors is calculated approximately in 0,85%, cousins sick sick 2.6% of cases, and for their brothers and sisters, the probability of infection is increased to 11 -14%.
The role of heredity in the occurrence of schizophrenia is well illustrated by the results of the study of morbidity among the twins. Many authors have shown that if one identical twin is ill with schizophrenia, the second gets sick in 77,6-91,5% of cases. In contrast, in pairs duagava twins disease twin single second ill just 15-16% of cases. All these data testify to the role of hereditary factors in the origin of schizophrenia.
Among the exogenous factors that can influence the development of schizophrenia, specify various infections, trauma, poisoning and so on, But there is no credible evidence of a causal relationship of these factors with the emergence of schizophrenic process.
Many believe that the incidence of schizophrenia certain influence can have a social factors. The study of the incidence of schizophrenia among different segments of the U.S. population has revealed a certain correlation between the incidence and level of material well-being investigated contingents. The lower level of life of a particular group of the population, the higher was in it, the incidence of schizophrenia [Hollingshead and Redlich (A. Century Hollingshead, F. S. Bedlich)]. However, the problem of causality between the etiology of schizophrenia and socio-economic factors is complex and currently does not have a unique solution.
Among the hypotheses of the pathogenesis of schizophrenia is the most common hypothesis autointoxication nature of this disease. It is assumed that in the body of patients with schizophrenia are formed toxic products of metabolism that can cause dysfunction of the Central nervous system. For a long time, many researchers have tried to allocate from the body of patients with schizophrenia these toxic compounds and study their properties. Autointoxication hypothesis of schizophrenia has many different options, the essence of which is determined by the violation of an clink of metabolism in a sick body. So, Buscaino the main source of toxic products in schizophrenia considered broken currency aromatic amino acids (aminooxidase hypothesis). In the future, as substances of concern schizophrenic toxicosis expected adrenochrome, adrenalin and serotonin.
However, not received convincing evidence of the existence of specific disorders in any of these links of metabolism in schizophrenia. A significant number of studies on their study of "toxic" actions biological liquids schizophrenic patients on various objects of plant and animal origin, only indirectly indicates the existence of abnormal metabolites in the body of these patients.
More significant results were obtained in the study patobiologice shifts in clinically homogeneous groups of patients with schizophrenia. Studying patients with periodic catatonia, Essing (R. Gjessing), has shown that the violation of protein metabolism (delay or elevated secretion from the body of nitrogen products) coincide with the characteristics of the clinical manifestations of the disease. Were allocated two forms of schizophrenia: asynchronously-bintana (with unfavorable course) and synchronous-sintonia (with a favorable type of the current process). However, these laws concerned only schizophrenia occurring periodically dominated the clinical picture of the disease catatonic disorders.
A significant place the violation of protein metabolism in the pathogenesis of schizophrenia paid B. N. Protopopov. He assumed that these violations occur on constitutionally prepared the soil (congenital deficiency of the endocrine system, reduced the antitoxic function of the liver, constitutional weakness of nerve cells in the Central nervous system).
A necessary element of a comprehensive study of the pathogenesis of schizophrenia at different levels of organization of biological systems of the body are studying processes of the higher nervous activity. Assumptions I. P. Pavlov about the nature of disorders of the higher nervous activity under mental illness, in particular in schizophrenia, became the basis for the further development of this problem. Representatives of this trend consider changing the normal interaction of the nervous processes in the cortex and subcortical areas, violation of the processes of irradiation and concentration braking, the emergence hypnogenic States, and so on, as pathogenetic mechanisms of various forms of schizophrenia.
Finally, the clinical method as a tool to study the pathogenesis of schizophrenia has recently received considerable development.


Continuous schizophrenia. Depending on the severity (progression) is divided into malignant, moderately having a progressive and slowly flowing schizophrenia.
Treatment. In the treatment of schizophrenia use so-called active methods (insulin shock therapy, treatment with psychotropic drugs), and also seek to influence the personality of the patient to better his re-adaptation (see Psychotherapy). Great importance has conducted an outpatient maintenance treatment with psychotropic drugs (see) patients discharged from psychiatric hospitals and in a state of remission. Using maintenance therapy can make more complete remission and long. Maintenance therapy affects the exacerbation of the disease: when conducting systematic re-paced attack may become easier and shorter.
The nurse can provide supportive therapy in cases when it has a specific and clear instructions of the doctor in relation to the patient.
Suspected schizophrenia urgent need to refer the patient to the doctor-psychiatrist.

Over and diagnosis
Onset date falls more often on the age of 16-25 years. Hence the old name - "early (premature) dementia". But not so rare cases earlier (in children) and late (aged over 50) disease onset.
A great variety of clinical manifestations of the disease makes necessary allocation of individual forms, differing symptoms and over.
The most widespread classification of schizophrenia, starting from the selection of the prevailing syndrome. So distinguished catatonic, hebephrenic, paranoid (hallucinatory-paranoid), simple forms of schizophrenia. Many psychiatrists allocate in addition to the basic hypochondriac, circular, neurozo - and psychopathic form.
Recently, when more fully explored peculiarities of clinical course, we found significant syndromal variability of schizophrenia. In this regard, the classification of schizophrenia, coming only from the principle of "leading syndrome", ceased to satisfy the psychiatrists. A more adequate classification is schizophrenia, which is considered as the predominant symptoms, and the type of course, the degree of progression of the disease. Allocate on the basis of the current three main forms of schizophrenia: 1) continuous current; 2) periodic; 3) pristupoobrazna-having a progressive (subhabrata; from the German Schub - attack, shift).
This classification covers all syndromology schizophrenia and allows to trace the development of the disease over time.

For the treatment of schizophrenia use of biological methods of shock therapy, psychopharmacotherapy), and also seek to influence the personality of the patient for the purpose of their rehabilitation psychotherapy (see), occupational therapy (see)].
Of biological methods of treatment of the most widely used psihofarmakoterapia. Used psychotropic substances belonging into three main groups - Psycholeptics ("large doses"), Psychoanaleptics (antidepressants) and "minor tranquilizers (see Psychopharmacology). Psychotropic substance used in the form of a course of treatment for the relief of acute illness or outpatient basis in the form of maintenance therapy. Unlike shock therapies, the choice of medication depends on the structure of psychopathological syndrome, which defines the beginning of treatment the clinical picture of acute [see Insulin (insulin therapy psychosis), Electroconvulsive therapy].
With the depressed state is mainly used antidepressants, sedative action (nozinan, amitriptyline and others). When low current processes, as well as during maintenance therapy, in addition to the above drugs (in small doses), apply Librium (Elenium), meprobamate (andaxin, Miltown), valium.
Insulin in the form of a rate of 15-20 comatose States apply at a periodic form of schizophrenia.