Schizophrenia is not easy to differentiate from other mental disorders. Moreover, even after identifying this pathology, it is necessary to correctly determine its variety, of which there are many. Circular schizophrenia is one of the milder forms of this psychopathology, which is more like an affective disorder. Consider its features, symptoms, and signs.

circular schizophrenia

General Information on Circular Schizophrenia

Circular schizophrenia, which is included in the F25 section of the International Classification of Diseases (ICD-10), has several names – recurrent and periodic. It is also often referred to as schizoaffective psychosis. This is due to the fact that it is characterized by two types of signs related to different disorders:

  • Symptoms of an affective disorder – mood swings, depressive symptoms, etc.
  • Manifestations of the schizophrenic type – delirium, catatonia, and hallucinations.

In this case, the first group of features, as a rule, is dominant. Therefore, circular schizophrenia is considered one of the mildest forms of schizophrenia spectrum diseases. However, it is worth mentioning here. This type of illness proceeds more favorably than other types of schizophrenia, especially paranoid and hebephrenic. But still, it is somewhat more severe than affective disorders, for example, bipolar or depressive.

The prevalence of intermittent schizophrenia is less than 1% of the general population.

The exact causes of circular schizophrenia are unknown. It is often genetically determined.

Also, statistics show that it often develops in hyperthymic – individuals with such character traits as openness, sincerity, sociability, flexibility, etc. A variety of factors can provoke an aggravation of the pathology, including stress, violence, psychological problems, divorce, death of a loved one, alcoholism, etc.

 

Symptoms of Circular Schizophrenia

Circular schizophrenia has several forms of course. Depending on the specific scenario, certain signs are observed. In general, the symptoms of the disorder can be represented as follows:

  • Apathy. The person becomes indifferent and lacks initiative. He is not even interested in activities that used to bring pleasure.
  • The senselessness of action. As a rule, such a patient wanders around the apartment or lies. He wants nothing as if he is developing severe depression.
  • Sleep disorders. A person falls asleep badly, often wakes up at night, sees a lot of nightmares or bizarre dreams, he loses his routine. During the day, he walks sluggish and sleepy, and sometimes falls asleep, as a result of which he sleeps even worse at night.
  • Increased anxiety. The patient is worried about and, he is constantly worried about something as if some kind of trouble is coming. Moreover, he himself can not really explain what exactly should happen.

These signs are more related to affective disorders. They are also often observed in the negative phase of schizophrenia, including just before the attack.

 

Stages of Circular Schizophrenia

Symptoms may increase gradually as the pathology progresses. There are 5 stages of its development:

  • Elementary. The first violations of emotional reactions occur. A person’s mood changes dramatically without exposure to external stimuli. Vegetative symptoms are possible in the form of headache, discomfort in the internal organs, and increased pressure.
  • Staged. Crazy ideas appear, although the patient still perceives the surrounding world adequately. It begins to seem to him that all his thoughts are open to strangers, and someone from the outside controls his actions.
  • Antagonistic nonsense. The world in the patient’s imagination is divided into good and bad, good and evil. There is a constant conflict between the two forces. Man considers himself one of the main participants in this struggle.
  • Oneiroid obscuration. It resembles a catatonic stupor when the patient freezes for a long time in one position. As a rule, at this moment he observes fantastic visions.
  • Fading. The symptomatology of the attack weakens, and the symptoms characteristic of the negative period of schizophrenia reappear.

The nature of the exacerbation depends on its form. Consider briefly the types of attacks of circular schizophrenia.

 

Oneiroid-catatonic

In this state, the patient is at the mercy of his fantasies, including conquering the world and flying to other planets. At the same time, he often freezes, as in a catatonic syndrome, in an unnatural position. Stupor may be replaced by physical activity. The attack lasts from 2 to 10 days, during which the patient does not lose full touch with reality. If he is not in a stupor, then he can navigate in space.

An oneiroid-catatonic attack usually occurs between the ages of 17 and 25.

The attack develops spontaneously. There are no specific signs by which it would be possible to determine the onset of an exacerbation. Unless, before a stupor, the patient behaves too excitedly, performing many stereotypical and meaningless actions. Mild delusional disorders are also possible 1-2 months before the onset of an attack.

 

Oriented Oneiroid

The second type of attack is not accompanied by a catatonic syndrome. If the patient does not move, then only because of the lack of desire to do anything. He is in his fantasies, looking aloof and silent. He answers questions in monosyllables and without enthusiasm. From the side, it is difficult to say whether he is healthy or not. Spatial and temporal orientation is preserved. Inappropriate behavior usually does not happen.

The fantasies that the patient is busy with do not contradict the laws of physics. They are more like reflections. A person would be happy to get rid of them and understand that something is wrong with him, but he cannot help himself. The attack lasts 2-10 days. Upon its completion, the patient can tell about all his fantasies, which later seem to him to be waking dreams.

 

Oneiroid clouding of consciousness

Confusion of consciousness is a departure from reality. A person is not just immersed in his inner world, full of fantastic experiences, but completely abstracted from the surrounding reality. The real personality of a person is replaced by a fictional one. He considers himself a great politician, inventor, or even a space traveler.

It is noteworthy that after leaving the attack, a person can tell about all his visions since he does not have amnesia. Typically, patients report that it all starts with ordinary experiences that gradually deepen. They themselves do not notice how they become participants in the grandiose events that unfold in their heads.

 

Dreamlike fantasy-illusory

In this case, the patient is faced with very vivid fantasies, as if he were in a different reality. Some patients tell after coming out of an attack that they were a different person or substance that moved to other worlds.

At the same time, it should be understood that there is no clear scenario in the patient’s head. Because of the inability to concentrate on anything, in particular, he sees how one picture replaces another, as, for example, happens with a person who cannot sleep and scrolls through many events, ideas, and fantasies in his mind. It’s just that a schizophrenic is much brighter. Moreover, he believes in them. Only after the normalization of the state, did he understand that these were just fantasies.

 

Expansive oneiroid

With the development of this attack, symptoms of an affective disorder appear. We are talking, first of all, about internal experiences, which often bring the patient to an ecstatic state. Often patients later talk about space adventures and about the presence of superpowers.

In this state, the patient does not pay attention to what is happening in reality. Time seems to be speeding up. This continues for several days. After that, the person comes out of the state of the attack. But at the same time, the symptoms of schizophrenia do not disappear. It just goes from positive to negative.

 

depressive oneiroid

As the name implies, with the development of this attack, the patient is disturbed by signs of a depressive disorder. Fantasies are present, but they become gloomy, religious, or mystical. When a person “turns on” to reality, he is always in a bad mood. Senestopathy may disturb – painful sensations inside and on the surface of the body. Hypochondria develops.

The patient does not want to contact people. If he communicates, he makes strange accusations against someone else. False recognitions are possible when a person recognizes a friend in a stranger. During such an attack, time, on the contrary, seems to slow down, which is manifested in the patient’s lethargy.

After the attack is over, a person cannot be critical of what happened, which greatly complicates the therapy.

A depressive oneiroid is prone to incorrect reflection. He finds in himself many vices and shortcomings, which in reality may not exist. Sometimes it seems to him that he is being followed. Symptoms of delusions associated with persecution are identified.

 

Acute paraphrenia

Paraphrenia is one of the most severe forms of delirium, unsystematized and completely illogical. As a rule, a person considers himself great, but at the same time, he cannot really explain the reason for his megalomania.

Delusional ideas are accompanied by pseudohallucinations – images that appear in the head in the absence of a real object.

In this condition, two unusual symptoms are often detected:

  • Confabulation – replacing true memories with false ones;
  • Cryptomnesia is the inability to distinguish memory from fiction.

After an attack, the patient can critically reflect on his condition.