Schizophrenia is a complex endogenous mental disorder that is difficult to treat. Many have heard about some of the features of this disease – crazy ideas, hallucinations, and manias. However, not everyone knows that it manifests itself in various forms, one of the most dangerous of which is febrile schizophrenia. It is accompanied not only by mental disorders but also by serious somatic symptoms. In the article, we will consider this syndrome in more detail.

Febrile schizophrenia

Key Features of Febrile schizophrenia

Febrile schizophrenia has many names – hypertoxic schizophrenia or catatonia, fatal, lethal, or febrile catatonia, etc. Such several names are associated with the complexity of defining the syndrome. It is not even included in the ICD-10, and its symptoms are so diverse that it is rather problematic to bring 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. Firstly, it is always accompanied by catatonia, that is, movement disorders. Secondly, it is characterized by a strong increase in body temperature, as in severe intoxication. For this reason, this form of schizophrenia is called hypertoxic.

Febrile schizophrenia occurs against the background of a schizophrenic attack, and is acute and rapid, requiring emergency care.

At different times in psychiatry, the signs of febrile schizophrenia were described as acute delirium, malignant mania, fatal hysteria, etc. The first attempts to isolate such symptoms into a separate group of psychoses were made by F.E. Foder in 1816. He divided acute delirium into febrile delirium, as well as into that observed in hepatitis, meningitis, and pneumonia. But he linked the syndrome to epilepsy, not schizophrenia.

For the first time, the syndrome, which today is called febrile schizophrenia, was described by the French psychiatrist Brière. He made a differential diagnosis and separated acute delirium from meningitis and acute mania. However, it is only today that scientists have begun to use relatively systematized data on this syndrome, even though it is not included in the International Classification of Diseases.

Since some doctors do have to deal with hypertoxic schizophrenia, they are usually trained to treat this syndrome, although it does not have a clear official name. Its prevalence is approximately 1:1000. Lethal outcome ranges from 11 to 73%.

It occurs, as a rule, at the first attack of the main mental pathology, often recurrent schizophrenia. Develops rapidly. A person can “burn out” in just a few days. In all cases, urgent hospitalization is required.

Causes of Febrile schizophrenia

Febrile schizophrenia develops only with a tendency to psychiatric disorders or against the background of an already diagnosed diagnosis. The exact reasons for science are still unknown. Scientists name only factors that can hypothetically provoke one form or another of schizophrenia. Among them are genetic predisposition, traumas, including birth and psychological, improper upbringing, personality traits, etc.

Directly febrile schizophrenia can cause:

However, there are cases when the disease developed in people who outwardly looked completely healthy and considered themselves as such. In other words, the trigger can be implicit. In such situations, treatment becomes even more difficult, since it is not known what exactly was the impetus for the development of an attack.

Symptoms of Febrile schizophrenia

Febrile schizophrenia is characterized by mental and vegetative (somatic) symptoms. They develop at the same time, and rapidly. The first type of signs are:

  • Catatonia;
  • Oneiroid stupefaction;
  • Hallucinations;
  • Rave.

Usually, it all starts with catatonic arousal, in which a person begins to perform stereotypical actions for no apparent reason, for example, brushing aside, hitting a wall, shifting objects from one place to another, making strange sounds, gesticulating aggressively, etc. To comments from other patients in this state do not respond.

After the excitation phase, the person falls into a catatonic stupor. He can take different poses, and unnatural, staying in them for a long time. Most often, the patient twists into the fetal position, but he can also stand still, arching. In a stupor, he is usually disturbed by hallucinations, often visual. He can hear everything that is happening around him and even make attempts to change his position, but he does not succeed.

In parallel with the listed signs, somatic symptoms develop:

  • Hyperthermia;
  • Bruising;
  • Skin redness;
  • Bullous dermatitis;
  • Toxicosis.

A typical manifestation of febrile schizophrenia is sudden temperature changes. It can rise to 40 °, but after a few hours fall to a normal level. This has a very negative effect on the state of internal organs. Also, quite often, blisters with serous contents appear on the skin. The patient scratches them and brings dirt, as a result of which various infections develop.

Oneiroid Catatonia

Oneiroid catatonia is a type of catatonic stupor when the patient “daydreams”. He not only freezes in one position but also goes into the inner world of fantastic visions. This state is preceded by excitement – high spirits, crazy ideas that are rapidly progressing, and general overexcitation. Suddenly, a person loses touch with reality and withdraws into himself.

As a rule, a painful condition betrays the inadequacy of a person’s behavior. His mood does not match the current situation. He can rejoice in completely joyless things, and also be afraid of what in the normal state does not cause even slight anxiety. The facial expressions of the patient are also some kind of pathological and do not correspond to the general emotional background in which he resides.

During stupor and hallucinations, a person can completely lose contact with the surrounding reality – he does not see or hear anything. After getting out of the attack, he begins to perceive his visions as memories, which leave their mark on the psyche and personality in general.

Amentative excitation

Augmentative excitation is a complication of oneiroid stupor, in which the patient is completely unaware of reality. Usually, he doesn’t even know where he is. Typical signs of this condition:

  • Cognitive decline;
  • Spatial disorientation;
  • Depersonalization and derealization;
  • Limited mobility;
  • Grimacing;
  • Speech disorders.

Often in this state, a person simply lies, not reacting to signals from the external environment. Sometimes his arms, legs, or facial muscles twitch. In some cases, it bends or takes a sitting position. Some patients remain mobile and walk, but perform meaningless activities, such as stroking something.

In a state of amental excitation, echolalia can be observed when a person shouts out different words that he recently heard in someone else’s speech.

Attempts to start a dialogue with the patient or seat him on the bed lead to outbursts of aggression.

Hyperkinetic Arousal

Hyperkinetic arousal may be the next stage in the development of the syndrome. In such cases, the delirium intensifies, becomes paranoid, patients twitch, arch, grimace and scream, and it is not always possible to make out the words. Sometimes it’s just some non-existent language. Signs of paranoia force the patient to hide, hide and arrange escapes.

All these symptoms are accompanied by vegetative manifestations – fever, diarrhea, rash, etc. Severe dehydration may develop. This stage ends with a strong catatonic stupor or complete amnesia. A fatal outcome is also possible, but this usually happens with a complete lack of treatment, as well as in cases where the hospital was contacted too late.

Diagnostics of Febrile schizophrenia

Febrile schizophrenia must be differentiated from another dangerous syndrome – neuroleptic malignant, which is also deadly and occurs as a result of taking psychotropic drugs, primarily neuroleptics. Many other pathologies should be excluded to make an accurate diagnosis.

Among them:

It will take time to accurately determine the diagnosis. However, a patient with febrile schizophrenia is an extremely serious condition, therefore, diagnostic measures are taken after the somatic symptoms have been eliminated. In other words, first, you need to conduct intensive therapy.

Treatment of Febrile schizophrenia

In the case of febrile schizophrenia, the patient should be urgently hospitalized in intensive care or a psychiatric hospital in the psycho-intensive care unit. In the first days of the disease, electroconvulsive therapy is used. If it is prescribed on time, it will take 3-5 sessions, after which the patient will feel much better. In the future, the effectiveness of this therapy decreases.

Significantly reduce mortality and allow hemosorption and plasmapheresis. The patient is observed around the clock, putting on a dropper. If necessary, bladder catheterization is performed to eliminate the risk of diuresis.

When signs of cerebral edema appear, that is, with the development of headache, nausea, oculomotor disorders, etc., diuretics, glucocorticosteroids, including prednisolone, and hypertonic glucose solutions are used.

It is not possible to eliminate the high temperature in febrile schizophrenia with the help of analgesics. Therefore, other methods are used – compresses with ice, which is applied to the areas of large vessels. Sometimes wet wraps are prescribed.

Therapeutic measures can be assigned a lot. The main task in such cases is to eliminate vegetative symptoms and prevent cerebral edema. Sudden changes in temperature, as well as other signs of the syndrome, greatly affect the condition of all organs. A person can die from damage to the lungs, liver, kidneys, etc. If this can be prevented, the patient is transferred to a hospital, where he is observed not only by therapists but also by psychiatrists.

Forecast

After the relief of the main symptoms, the patient remains in the clinic for at least 1-2 months. You need to get him to the hospital as soon as possible. The earlier treatment is started, the higher the likelihood of a favorable outcome.

However, about long-term forecasts, things are not so good. In the future, a relapse is possible, and it is rather difficult to prevent it since it can begin suddenly and for no apparent reason. Usually, patients are advised to give up bad habits, spend more time in the fresh air and periodically visit a psychologist.

If necessary, the doctor will prescribe medication for the period of remission. You will have to take them, strictly observing the dosage. At the first sign of exacerbation, you need to call an ambulance. In this case, the responsibility lies with the relatives of the patient.