Schizophrenia is a complicated endogenous mental disorder that is difficult to treat. Many people have heard about some of the features of this illness – delusions, hallucinations, and delusions. However, not everyone knows that it manifests in different forms, one of the most dangerous febrile schizophrenia. It is accompanied not only by mental disorders but also by severe somatic symptoms. In this article, we will discuss this febrile schizophrenia in more detail.
Main Features
Febrile schizophrenia has many names – hypertoxic schizophrenia or catatonia, lethal, lethal or febrile catatonia, etc. This number of names is due to the complexity of defining the syndrome. It is not even included in the ICD-10, and its symptomatology is so diverse that it is somewhat problematic to summarize all the signs under one name.
Febrile schizophrenia is considered one of the most successful names, as it reflects the dual nature of the syndrome. First, it is accompanied by catatonia, that is, movement disorders. Secondly, it is characterized by a substantial increase in body temperature, as in severe intoxication. For this reason, this form of schizophrenia is called hypertoxic.
Febrile schizophrenia runs against the background of a schizophrenic attack, and it is acute and rapid, requiring emergency care.
At different psychiatric epochs, the signs of febrile schizophrenia have been described as acute delirium, malignant mania, fatal hysteria, etc. The first attempts to separate such symptoms into a separate group of psychoses were made by F.E. Foder in 1816. He divided acute delirium into febrile delirium and that seen in hepatitis, meningitis, and pneumonia. But he associated the syndrome with epilepsy, not schizophrenia.
The syndrome, now called febrile schizophrenia, was first described by the French psychiatrist Briere. He made a differential diagnosis and separated acute delirium from meningitis and acute mania. However, scientists have only begun using relatively systematic data on this syndrome, although it is not included in the International Classification of Diseases.
Since some physicians encounter hypertoxic schizophrenia, they are usually trained to treat the syndrome, even though it does not have an exact official name. Its prevalence is about 1:1000. Fatalities range from 11% to 73%.
It occurs, as a rule, during the first attack of the underlying psychiatric pathology, often recurrent schizophrenia. It develops rapidly. The person can “burn out” in just a few days. In all cases, urgent hospitalization is required.
Causes
Febrile schizophrenia develops only when prone to psychiatric disorders or against the background of an already diagnosed illness. The exact causes are still unknown to science. Scientists name only factors that hypothetically can provoke one form of schizophrenia. These include genetic predisposition, trauma, birth and psychological, wrong upbringing, personality traits, etc.
Directly febrile schizophrenia can cause:
- Alcohol intoxication;
- Narcotic substances;
- Drug overdose;
- Infectious diseases of the brain.
However, there are known cases in which the disease has developed in people who looked perfectly healthy on the outside and considered themselves as such. In other words, the trigger can also be implicit. In such situations, treatment becomes even more complicated since it is unknown what exactly triggered the development of the attack.
Symptoms
Febrile schizophrenia is characterized by mental and vegetative (somatic) symptoms. They develop simultaneously and rapidly. The first type of symptoms include:
- Catatonia;
- Oneuroid delirium;
- Hallucinations;
- Delirium.
It usually begins with catatonic agitation, in which the person performs stereotypical actions for no apparent reason, such as swinging away, hitting the wall, moving objects from one place to another, making strange noises, gesticulating aggressively, etc. Patients in this state do not respond to comments from others.
After the arousal phase, the person falls into a catatonic stupor. The person may assume various unnatural postures and remain in them for long periods. The patient usually twists into a fetal position but can stand still and bend over. While in a stupor, he is usually disturbed by visual hallucinations. He can hear everything that is going on around him and even tries to change his posture but is unsuccessful.
Somatic symptoms develop in parallel with these signs:
- Hyperthermia;
- Bruising;
- Redness of the skin;
- Bullous dermatitis;
- Toxicosis.
A typical manifestation of febrile schizophrenia is abrupt fluctuations in temperature. It may rise to 40°, but in a few hours, fall back to normal. It has a very negative effect on the condition of the internal organs. Blisters with serous content also often appear on the skin. The patient scratches them and brings in the dirt, as a result of which various infections develop.
Diagnosis
Febrile schizophrenia must be differentiated from another dangerous syndrome – malignant neuroleptic syndrome, which is also deadly, and is caused by taking psychotropic drugs, primarily neuroleptics. There are many other pathologies that should be excluded in order to accurately make the diagnosis.
These include:
- Pneumonia and bronchitis;
- Adenovirus infection;
- Psychopharmacological delirium;
- Hemorrhagic stroke;
- Infectious meningitis;
- Viral encephalitis, etc.
It will take time to make an accurate diagnosis. However, a patient with febrile schizophrenia is severe, so diagnostic measures are taken after the somatic symptoms are eliminated. In other words, intensive therapy must be conducted first.
Treatment
In febrile schizophrenia, the patient should be urgently admitted to an intensive care unit or a psychiatric hospital in a psychological intensive care unit. Electroconvulsive therapy is used in the first days of the illness. If administered in time, it will require 3-5 sessions, after which the patient will feel much better. Later the effectiveness of this therapy decreases.
Significantly reduced mortality allows chemisorption and plasmapheresis. The patient is monitored around the clock, putting him on drips. If necessary, catheterization of the bladder is carried out, excluding the risk of diuresis.
If signs of cerebral edema develop, i.e., headache, nausea, oculomotor disorders, etc., diuretics, glucocorticosteroids, prednisolone, and hypertonic glucose solutions are used.
It is not possible to eliminate fever in febrile schizophrenia with analgesics. Therefore, other methods are used – compresses with ice, which is applied to the areas of large vessels. Sometimes wet wraps are prescribed.
Can prescribe a lot of therapeutic measures. The main task in such cases is to eliminate autonomic symptoms and prevent cerebral edema. Abrupt changes in temperature and other signs of the syndrome strongly affect the condition of all organs. The person may die from lesions, lungs, liver, kidneys, etc. If they can prevent this, the patient is transferred to a hospital, where therapists and psychiatrists monitor him.
Forecast
After the main symptoms have resolved, the patient stays in the clinic for at least 1-2 months. It is necessary to bring him to the hospital as soon as possible. The earlier treatment begins, the greater the likelihood of a favorable outcome.
However, the long-term prognosis is not so good. In the future, a relapse is possible, and it is pretty difficult to prevent since it can start suddenly and for no apparent reason. Patients are usually advised to give up their bad habits, to be out in the fresh air more often, and to visit a psychologist periodically.
If necessary, the doctor will prescribe medications for a period of remission. You will have to take them, carefully observing the dosage. At the first sign of an exacerbation, it is necessary to call an ambulance. In this case, the responsibility lies on the relatives of the patient.
