Schizophrenia is not easy to differentiate from other mental disorders. Moreover, even after identifying this pathology, it is necessary to identify its type, which there are many correctly. Circular schizophrenia is one of the milder types of this psychopathology, which is more similar to affective disorder. Let’s discuss its peculiarities, symptoms, and signs.
Circular schizophrenia, which falls under heading F25 of the International Classification of Diseases (ICD-10), has several names – recurrent and periodic. It is also often called schizoaffective psychosis. It is because it is characterized by two types of signs that belong to different disorders:
- Symptoms of affective disorder – mood swings, depressive signs, etc.
- Schizophrenic type symptoms – delirium, catatonia, and hallucinations.
At the same time, the first group of signs, as a rule, is dominant. For this reason, circular schizophrenia is considered one of the mildest forms of the schizophrenic spectrum. However, the caveat here. This disease variant runs more favorably than other types of schizophrenia, especially paranoid and hebephrenic. Still, it is more severe than affective disorders, such as bipolar or depressive disorders.
The prevalence of periodic 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 develops more often in hyperthymesia – personalities with character traits such as openness, sincerity, communicativeness, flexibility, etc. But to provoke the aggravation of the pathology can be a variety of factors, including stress, violence, psychological problems, divorce, death of a loved one, alcoholism, etc.
Circular schizophrenia has several forms of progression. Depending on the specific scenario, some or other signs are observed. In general, the symptoms of the disorder can be summarized as follows:
Apathy. The person becomes indifferent and non-initiative. He is not interested even in those activities which earlier brought pleasure.
The pointlessness of action. As a rule, such a patient hangs around the apartment or lies down. He does not want anything, as if he is developing severe depression.
Sleep disturbances. The person has trouble falling asleep, often wakes at night, has many nightmares or bizarre dreams, and has a disrupted sleep pattern. He walks lethargic and sleepy during the day, sometimes falling asleep, resulting in an even worse night’s sleep.
Increased anxiety. The patient is anxious for any reason, constantly worrying about something as if some misfortune is approaching. And he can not explain what is going to happen.
These signs are more related to affective disorders. They are also often observed in the negative phase of schizophrenia, including just before a attack.
Symptoms can increase gradually as the pathology progresses. There are five stages of its development:
- Initial. The first disorders of emotional reactions arise. A person’s mood changes sharply without the influence of external factors. Possible vegetative symptoms include headaches, discomfort in the internal organs, and increased blood pressure.
- Staging. Delusional ideas arise, although the patient perceives the world around him adequately. It seems to him that all his thoughts are open to others, and someone from outside directs his actions.
- Antagonistic delirium. The world in the patient’s imagination is divided into bad and good, good and evil. There is a constant confrontation between the two forces. The person considers themself to be one of the main participants in this struggle.
- Oneiroid delirium. It reminds one of a catatonic stupor when the patient stays for a long time in one position. As a rule, at this point, they observe fantastic apparitions.
- Fading. The symptoms of the attack subside, and the symptoms characteristic of the negative period of schizophrenia reappear.
The nature of the exacerbation depends on its form. Let us briefly consider the types of attacks of circular schizophrenia.
In such a state, the patient is at the mercy of his fantasies, including conquering worlds and flying to other planets. At the same time, he often stiffens, as in a catatonic syndrome, in an unnatural posture. The stupor may be replaced by physical activity. The attack lasts 2 to 10 days, during which the patient does not lose the full connection with reality. If they are not in a stupor, he or they can get their bearings.
Oneiroid-catatonic seizures usually occur between the ages of 17 and 25.
The attack develops spontaneously. There are no specific signs of the onset of an exacerbation. The patient behaves excessively agitated before the stupor, performing many stereotypical and nonsensical actions. Mild delirium may also occur 1 to 2 months before the onset of an attack.
A catatonic syndrome does not accompany the second kind of attack. If the patient does not move, it is only due to a lack of desire to do anything. He is in his fantasies and seems aloof and silent. He answers questions unilaterally and unenthusiastically. It is difficult to tell from the outside whether he is healthy. Spatial and temporal orientation is preserved. Bad behavior usually does not occur.
Fantasies, which the sick person is engaged in, do not contradict the laws of physics. They are more like reflections. The person would be happy to get rid of them and understands that something is wrong with them, but they cannot do anything about it. The attack lasts 2-10 days. At the end of this episode, the patient can talk about all of his fantasies, which later appear to him as real-life dreams.
Confusion is an abandonment of reality. A person is not just immersed in his inner world, full of fantastic experiences, but is completely abstracted from the surrounding reality. An imaginary one replaces a person’s real personality. He considers himself a great politician, an inventor, or a space traveller.
The fact that the person can narrate all his visions after the attack is noteworthy since he has no amnesia. Usually, patients say that everything starts with ordinary experiences, which gradually deepen. They don’t notice how they become participants in the glorious events unfolding in their heads.
In the development of this attack, symptoms of affective disorder occur. These are, above all, inner feelings which often bring the patient into an ecstatic state. Often patients subsequently talk about space adventures and the presence of their superpowers.
In such a state, the patient does not pay attention to what is happening in reality. Time seems to speed up. It goes on for several days. After that, the person comes out of the attack condition. But the symptoms of schizophrenia don’t disappear. Simply it turns from positive to negative.
As the name implies, when this episode develops, the patient is disturbed by symptoms of a depressive disorder. Fantasies are present, but they become gloomy, religious, or mystical. When the person is “turned on” to reality, he is always in a bad mood. Senestopathy – painful sensations inside and on the body’s surface – may disturb. Hypochondria develops.
The patient has no desire to have any contact with people. If he communicates with others, he ventures into strange accusations. False recognition is possible when the person recognizes an acquaintance of a stranger. During such an attack, on the contrary, time seems to slow down, which manifests itself in the lethargy of the patient.
After the episode, the person cannot reflect critically on what happened, which greatly complicates the therapy.
A depressive oneroid is prone to inappropriate reflection. He finds many flaws and faults in himself that may not be there in reality. Sometimes he feels that he is being followed. Symptoms of delusions connected with stalking are revealed.
Paraphrenia is one of the most severe types of delusion, unsystematic and completely illogical. As a rule, a person thinks they are great but cannot explain the reason for their delusions of grandeur.
Pseudo-hallucinations accompany delusions – images appearing in the head without a real object.
Two unusual symptoms are often detected in this condition:
- Confabulation – replacement of true memories with false ones;
- Cryptomnesia – inability to distinguish between memory and fiction.
After an attack, the patient can critically reflect on his condition.
Approximately 25% of patients go into long-term remission for 5-8 years after the first exacerbation. However, residual effects remain in almost all cases. We are talking about severe mood swings, isolation and asthenic symptoms. During a period of “calm”, treatment continues with the help of drugs and psychotherapeutic methods.