Schizophrenia is a very diverse and unpredictable mental illness. It can manifest itself in different types. There are more than a dozen types of this psychopathology. Some of them get their name from the dominant symptom. If the patient’s main symptom is hypochondria, hypochondriacal schizophrenia is diagnosed. Let’s find out what its peculiarities are.

hypochondriacal schizophrenia

 

 

General information

Hypochondriacal schizophrenia, as a separate clinical form of the endogenous pathological process, was first described in 1928 by psychiatrist M. Bornstein. He characterized it as a disorder with a sudden debut, favorable onset, and complete remission without obvious schizophrenic defect.

Domestic psychiatrists V.A. Gilyarovsky and M.O. Gurevich also considered this psychopathology a separate form of schizophrenia. Their manuals described it as a type of schizophrenic disorder with a flaccid benign course, which manifests itself mainly in cenesthopathic hypochondriacal signs.

In the International Classification of Diseases of the tenth revision (ICD-10), hypochondriacal schizophrenia is absent. Many psychiatrists consider this form a low grade, characterized by prolonged development without marked symptoms.

It can take decades, from the onset of the first signs of hypochondria to the appearance of clear symptoms of schizophrenia.

The main clinical manifestation of this type of schizophrenic disorder is hypochondria. Let us consider this concept in more detail.

 

About Hypochondria

In simple terms, hypochondria is a fear of illness. The term is translated from Greek as “subcostal area. In ancient times, believed that this area of the body was the source of a person’s hypochondriac condition. 2,000 years ago, it was considered a somatic disease affecting the subcostal region. In the seventeenth century, hypochondria began to be called melancholy.

Today, the word refers to a mental disorder in which there is a false belief that a person has a bodily illness. In the ICD-10, the hypochondriacal disorder is included under the heading of somatoform disorders (F45), which are reversible. At the same time, hypochondria can be both a primary pathology and a secondary one, developed in the background of an affective disorder.

The exact causes of hypochondria are unknown. It is believed that it often affects depressive, anxious, and anxious individuals. Sometimes it is explained as an unconscious way to mask a depressive state. Also, hypochondria can develop after a serious illness or observation of a person with a scary diagnosis.

In all cases, he is convinced that he is sick, suffering, and experiencing somatic symptoms. The latter may cause increased anxiety. The person has something sick, remembers that his father died of similar heart pains, and concludes that he must die soon, too.

Anxiety triggers protective mechanisms in the brain, giving appropriate orders to the nervous system, and it, in turn, activates the work of the internal organs. As a result, a person’s heart starts to beat faster, and the pressure rises.

See Also: What Is Somatic Symptom Disorder?

Such physiological reactions to stress are normal. If a person doesn’t have pathologies of the internal organs (and hypochondriacs don’t have them, as a rule), then you don’t need to worry. But palpitations increase anxiety even more. As a result, a certain vicious circle is formed, triggered by certain bodily and mental stimuli. A person can live in this condition for decades. In this case, he usually has no serious illnesses detected during all these years.

Often hypochondria begins to manifest itself at 18-25 years old, becoming stronger with each passing year.

The consequences of hypochondria can be unfortunate. The person is constantly afraid, checks his health several times a month, and spends a lot of time, energy, and money on procedures and medications, but it does not get better. The suicide rate is quite high with this disorder. The patient gets so tired of his “illnesses” that he decides to quit his life.

Hypochondria is well treated. It is just that such a person should not be treated by a therapist, to whom the hypochondriac constantly turns, but by a psychiatrist or psychotherapist.

 

Hypochondriacal schizophrenia

Schizophrenia has two types of symptoms – negative and positive. The former is the result of a passive psyche. They usually occur before an attack. They include apathy, increased fatigue, lack of interest, anhedonia (inability to get pleasure), isolation, etc.

Positive (productive) symptoms are observed during the active phase of the disease when the mental apparatus of the person works in an increased mode. At such moments, the patient develops delusions, including those associated with hypochondria, hallucinations, and motor disorders (catatonic syndrome).

In the slightly to distinguish between negative and positive symptoms. They can, with a sluggish form, superimposed on each other. Overall, signs are poorly pronounced; therefore, not all people attach great importance to them, explaining them by fatigue, fatigue, lack of sleep, and hypochondria – somatic illnesses.

It is possible to distinguish the following symptoms that are observed in different patients with hypochondriacal schizophrenia:

  • Confidence in the presence of a bodily illness;
  • Constant complaints of ill health;
  • Increased fatigue;
  • A depressive state;
  • isolation, aloofness;
  • Obsessive thoughts;
  • Outbursts of aggression.

Such signs can also occur seen in a healthy person without mental or somatic illnesses. If there are several of these symptoms and they do not go away for months and years, it is worth seeing a psychotherapist.

As a rule, people with hypochondria often go to ordinary doctors who do not find any pathology. As a result, the patient sees a psychiatrist several years after the first symptoms of schizophrenia.

Hallucinations and systematized delusions usually occur in schizophrenia but are not observed in the hypochondriac form.

Let us consider the three main symptoms of hypochondriacal schizophrenia in more detail. We are talking about hypochondriac syndrome, senestopathies, and asthenia.

 

Hypochondriacal Syndrome

A hypochondriac’s main concern is the condition of his stomach, intestines, brain, genitals, and, of course, his heart. Any tingling he perceives as a dangerous attack. The problem is that such a thought activates the sympathetic branch of the autonomic nervous system. It adjusts to “fight or flight” mode. The person’s heart rate increases, temperature and blood pressure rise, muscles tense, sweat released, etc.

Tense muscles send a signal back to the brain, telling it that they are tense and ready for action. A person in this state sits, lies down, is at a meeting, an exam, or is riding the subway. His panic intensifies, his cortisol level in the blood rises, and his bodily manifestations of anxiety become more pronounced. In such a state, the “sick person” may even faint. True, the cause of this will not be bodily but mental.

See Also: Remission in schizophrenia.

The stimulus for a panic attack can be pain and discomfort or an external irritant, such as the noise of the subway. If a person is once afraid of it, he will be more and more each time until he works through this fear. At such moments, the patient can replay in his head the most terrible scenarios of his death, which further intensify the anxiety and its bodily manifestations.

Untreated, this kind of symptomatology will begin to intensify. The person will develop obsessions and compulsions, forcing him to perform a variety of rituals to protect himself from danger. It is also not uncommon for the patient to begin taking a variety of medications that are either useless or harmful. In the absence of an actual illness, it is not necessary to drink them. Doctors also try to convince him, but he doesn’t believe them and changes one clinic for another. If he is lucky, he will be at the psychotherapist’s office.

 

Senestopathy

Senestopathies refer to painful sensations on the body’s surface or in the area of internal organs. They can be very different, but as a rule, they have no pathological cause. Quite often, such a symptom is called “somatic hallucinations” because it is only indirectly related to somatics, resulting from incorrect work of the mental apparatus.

Often, when a person complains about an object in the chest, electrical impulses passing through the arms, a feeling of movement in the ear, burning sensations in the legs, the presence of acid in the veins, and other “strange” symptoms, they occur in the case of senestopathies. They develop in schizophrenia, including senestopathies and hypochondriac, bipolar disorder, severe depression, and other affective disorders.

According to European doctors, various forms of hypochondria affect about 10% of people.

Senestopathies are observed in various forms of schizophrenia, but a persistent or severe schizophrenic defect rarely accompanies them without being reflected in personality traits. The latter are usually threatened by other symptoms, including delirium and hallucinations.

Senestopathies are one of the most frequent but not very dangerous signs of psychopathology. In hypochondriacal schizophrenia, if a psychiatrist treats the patient, it is possible to get rid of painful bodily sensations forever.

 

Asthenic syndrome

Asthenia is translated from Greek as “helplessness. Usually, it is called the syndrome of increased fatigue, in which a person is constantly tired and quickly exhausted. But this is too superficial a definition. Asthenic disorder can have many symptoms.

A person becomes restless, impatient, irritable, frightened of loud sounds and bright lights, cannot stand sharp smells, is disturbed sleep, and his cognitive abilities deteriorate. Memory impairment may occur.

As a rule, with asthenia, people are inconsistent, anxious, and perpetually dissatisfied with something. Such symptoms do not help to overcome either sleep or rest. The person becomes weak and passive. Sometimes he has outbursts of aggression or fits of agitation. But they are short-lived; after them, the patient feels even more tired. At first, he may snap at someone shouting, and after a few minutes, he complains and cries.

Several of these signs indicate a developing disorder, which is unlikely to be cured by valerian or motherwort. But most people justify these symptoms by stress at work and lack of sleep, not mental illness, much less schizophrenia.

 

Changes in Personality

The hypochondriac type does not cause a pronounced lesion or obvious disintegration of the personality, as it happens in hebephrenic or paranoid schizophrenia. However, it cannot say that the person remains the same after the onset of the disease. Such patients become moody, withdrawn, and irritable. It becomes difficult to communicate with them. They avoid people, but the latter also shun them.

Often such persons become interested in mystical doctrines, join sects, and so forth. Their social circle narrows further. Former acquaintances no longer understand what is happening to their friends or family member. The problem is that the disease develops very slowly, so the patient’s character changes gradually. Not everyone would think that hypochondriacal schizophrenia is the cause.

 

Treatment of Hypochondriacal Schizophrenia

Hypochondriacal schizophrenia is treated with medication, antipsychotics, and psychotherapy, usually cognitive-behavioral and problem-oriented therapy. Treatment is done on an outpatient basis. Inpatient treatment is required only if severe depression develops and the patient has suicidal thoughts.

A general improvement in the condition is observed within 2-4 weeks after taking the medication. After several months, practically all symptoms disappear. The medications may have to be taken for several years and visit a psychiatrist, but in most cases, doctors achieve stable remission. Usually, the disease does not return.

Great importance is given to group psychotherapy sessions that restore communication skills.

To avoid a relapse, the person is recommended to lead a healthy lifestyle (but without fanaticism), be outdoors more often, engage in spiritual development (without joining sects), and periodically visit a psychiatrist. Hypochondriacal schizophrenia, unlike its other forms, can be eliminated. All negative changes that happen to a person during illness are reversible.

 

Sources:
  • https://pubmed.ncbi.nlm.nih.gov/3072051/