Schizophrenia has many clinical variants that differ from each other in the number of symptoms and the rate of progression. More dangerous are continuously flowing ones since sooner or later they lead to the disintegration of the personality. Malignant juvenile schizophrenia is one such form. It develops early and rapidly, leading to a severe schizophrenic defect.
Pictures of Malignant Juvenile Schizophrenia
There is no diagnosis of juvenile schizophrenia in the International Classification of Diseases. So doctors conditionally designate psychopathology, which develops in adolescence and youth. Sometimes it is called juvenile (juvenile). If we talk about the nature of the course, then, as a rule, this form of schizophrenia becomes malignant. This means that it is characterized by a high level of progression, which corresponds to a gradual and rapid increase in symptoms.
Often such schizophrenia manifests itself at the age of 14-15. This age is considered the riskiest. However, it can develop at 10 and at 18-19 years. In most cases, the patients are boys. -In girls, this psychopathology is detected 4-5 times less often. In general, the prevalence of the malignant type of juvenile schizophrenia is 5-6% of the total number of schizophrenic patients.
Malignant juvenile schizophrenia may end 2-3 years after the onset of a severe schizophrenic defect.
In general, there are five features of juvenile schizophrenia that distinguish it from other forms of psychopathology:
- Early manifestation. The disease begins mainly in adolescence, less often – before 12 or after 17-18 years.
- Negative symptoms appear before the first psychosis. The rapid development of the disease does not always allow to start treatment on time.
- Syndromic incompleteness during the onset of the disease. This means that the clinical picture consists of signs related to different syndromes.
- Resistance to therapy. Medications and other treatments do not bring the desired effect, and as a result of which schizophrenia continues to progress.
- The presence of a simplex syndrome, in which a teenager acquires features that were previously unusual for him. He suddenly becomes rough and withdrawn. Forget about the basic rules of hygiene.
The disease always begins with negative symptoms, after which there is a period of exacerbation. The set of symptoms is determined by the type of malignant juvenile form of schizophrenia. There are four of them – simple, hebephrenic, paranoid, and catatonic.
Prior to the manifestation of simple schizophrenia, the teenager abruptly becomes lethargic and inactive. The energy potential is noticeably reduced, which is clearly shown by the marks he received at school. At first, parents and teachers attribute this to overwork, but later it becomes clear that the child cannot cope with the task due to cognitive impairment. He simply does not learn the material being asked.
Teenagers lose their motivation. He begins to roam the streets, wandering, refusing to wash and brush his teeth. His social circle is shrinking. He contacts only those close to him, but more out of necessity than desire.
Often the patient begins to get involved in spiritual or narrowly scientific topics – religion, mysticism, nuclear physics, etc. He picks up a bunch of books in the library and reads something. But often they simply do not understand what they read. If you ask him what he learned new from books, he will answer something unintelligible. Sometimes they stay open on the same page for weeks. This phenomenon is called “metaphysical intoxication”.
The following negative signs of simple malignant juvenile schizophrenia can be distinguished:
- Decreased ability to process information;
- Impossibility of forming new skills;
- Isolation, emotional coldness;
- Lack of motivation, abulia, apathy, chronic fatigue;
- Sexual disinhibition;
- Primitive reasoning, isolation from reality.
Periodically, positive symptoms may occur that indicate the activity of the mental apparatus. Among them:
- Slight elation of mood, combined with irritation;
- Sexual promiscuity, promiscuity;
- Addiction to alcohol, drugs, and vagrancy;
- Delusional disorders and hallucinations;
- Catatonic syndrome – brief freezing in one position.
There is also a simplex syndrome. All these signs may be unexpressed for some time. But the presence of several of them is already a reason for a visit to a psychotherapist. Especially such symptoms are striking when previously the child was a completely different – exemplary, obedient, excellent student, etc.
Hebephrenic schizophrenia is named after Hebe, the ancient Greek goddess of youth. Patients in the development of this form of the disorder behave too childishly, foolishly. In contrast to the simple type of disease described above, in this case, there are more productive symptoms. As a rule, we are talking about delusions of persecution, auditory hallucinations, mental automatism, and movement disorder.
The main symptoms that occur in malignant juvenile hebephrenic schizophrenia are:
- Feigned, foolish, clownish behavior;
- Constant antics and ridiculous protests;
- Isolation, combined with rudeness;
- Frequent use of obscene language in speech;
- Auto-aggression manifested in self-hatred;
- Delusional statements that do not correspond to facial expressions.
Somatic symptoms are also possible – fever, fever, change in skin tone, etc. But they usually pass without therapeutic help.
Hallucinations in this form of schizophrenia do not lead to hallucinosis, and delirium remains ridiculous and unsystematic.
There are two variants of hebephrenic malignant schizophrenia – delusional and catatonic. In the first case, delusional ideas prevail, but superficial ones. In the second – movement disorders, but, as a rule, short-term. The patient is overly excited, sometimes falls into a stupor, but periodically makes senseless impulsive movements.
Movement disorders are a key symptom of catatonic malignant juvenile schizophrenia. At the same time, there is no oneiroid stupefaction when the patient is in a stupor, but at the same time, he sees hallucinations. This form of pathology is characterized by the so-called lucid catatonia, which is also called pure or transparent. This means that by falling into a stupor, the patient has negative signs and not productive ones.
- Inappropriate, foolish behavior;
- Sudden change of mood;
- Alternation of stupor and excitations;
- Negative symptoms.
Sometimes a teenager freezes for a long time in an elaborate pose or sways and swings his arms. In this state, he may shout out strange words or, on the contrary, become silent, refusing to answer questions.
There is also a tendency to repeat their movements and words after other people – echolalia and echopraxia.
With catatonic schizophrenia, the patient can play primitive games, shifting objects from one place to another for hours.
As the pathology progresses, negative symptoms intensify, which leads to mental retardation.
Paranoid juvenile schizophrenia of the malignant type is similar to the adult paranoid form. But in the first case, there is a simplex syndrome. The following symptoms may also be observed:
- Obsessions and compulsions, obsessive rituals;
- Dysmorphophobia – the belief that one has deformity;
- Crazy ideas for different content;
- Hypochondria – fear of getting infected and getting sick;
Delusions can be associated with megalomania or reformism when the patient believes that he has discovered something incredible for all of humanity. Some patients are convinced that they are adopted children, and their parents are strangers.
In general, delirium is not systematized and is not very persistent. However, as the disease progresses, signs of the Kandinsky-Clerambault syndrome appear. It is also called the “mastery syndrome“. It seems to a person that someone else controls his thoughts, actions, and feelings.
The main symptoms of this condition are called automatism:
- Mentism is an influx of thoughts, images, and memories that a person is not able to control.
- Ideational automatisms. The patient believes that third parties control his thoughts, they put ideas into his head and control them. Sometimes it seems to a person that all his thoughts are available to others.
- Senestopathy. They manifest themselves in somatic signs. The patient feels strange bodily ailments or discomfort in the area of \u200b\u200bthe internal organs. Moreover, he is sure that extraneous forces, for example, aliens, are the cause of these signs.
- Motor automatisms. In this case, we are talking about movements that, according to the schizophrenic, are performed not by him, but by someone else. In such situations, numbness and paralysis are possible.
Due to constant dissatisfaction with their appearance, patients insist on plastic surgery. Some of them are very thin. But regardless of whether they improve their appearance or not, they remain dissatisfied with it. Often there are no defects and shortcomings in reality, and all of them are far-fetched.
Effects of Malignant Juvenile Schizophrenia
In most cases, malignant juvenile schizophrenia ends with a persistent schizophrenic defect, and psychosis ends as early as 2-3 years after the manifestation. If a patient develops a simple form of the disease, he has apathetic dementia. With catatonic or hebephrenic variants of the course of the disease, foolish and mannered dementia comes.
The paranoid form ends with schizophasia – speech discontinuity, when the patient, if he speaks, then mostly meaningless words. He builds complex sentences, but they do not carry any meaning.
In general, any schizophrenia that manifests in childhood has an unfavorable course. The earlier the signs of the disease appear, the more severe the consequences will be. In almost all cases, dysontogenesis is observed – a violation of the development of the psyche or its individual components.
It differs in the time of formation:
- Domanifest. Leads to early childhood autism and psychopathy.
- Procedural. It begins to manifest itself in the course of the development of pathology and progresses along with it.
- Post-procedural. Causes delays in mental development, which become noticeable after the completion of the acute phase of psychosis.
Remissions in malignant juvenile schizophrenia are rare and short-lived. Often they are indistinct. As a rule, some signs and stages are superimposed on others, so it is quite difficult to distinguish between a disease into negative and productive symptoms.
Often parents attribute changes in their child’s behavior to a difficult age or “bad company”. Because of this, time is wasted that could have been spent on treatment.
A schizophrenic defect greatly complicates the further functioning of a schizophrenic in society. It is difficult for him to study and do his job. Sometimes it just closes and does not react to the environment. He becomes indifferent to his own fate and the lives of his loved ones.
Diagnosis and treatment of Malignant Juvenile Schizophrenia
If schizophrenia is suspected, a person receives referrals for many studies – laboratory, instrumental and psychotherapeutic. To make an accurate diagnosis, to differentiate malignant schizophrenia from other forms of this disorder or other mental illnesses, the child has to be observed for several weeks or months.
Often the disease is detected late when there is an extensive set of symptoms. Often the patient is hospitalized forcibly, for example, from the street, when he sticks to passers-by or walks around naked. Late diagnosis complicates the treatment of an already complex disease.
In the active phase, the patient is prescribed antipsychotics, in the negative phase, antidepressants. However, often patients have resistance to drug therapy. They do not help to stop the main symptoms and bring a person into a relatively stable emotional state.
Psychotherapy plays an important role in treatment. The patient attends single and group sessions. He needs to understand that he is sick and accept himself in this form. Relatives of a schizophrenic are also consulted, who will have to learn how to interact with him correctly.
Treatment is lifelong, as there is no cure for schizophrenia. Even if it was possible to bring a person into a state of long-term remission, he will forever remain at risk. As medical practice shows, this risk in malignant juvenile schizophrenia is very high.
Prevention of Malignant Juvenile Schizophrenia
Specific measures for the prevention of juvenile schizophrenia do not exist, since the etiology and pathogenesis of the disease are unknown. Doctors only give recommendations, following which will help reduce the likelihood of an exacerbation. The patient is advised to visit a psychiatrist regularly, give up bad habits, walk in the fresh air and eat right.
Relatives should learn to identify the onset of an attack by the first symptoms in order to seek help from a doctor in time. Scientists advise adults to approach education more responsibly, since stress, conflicts in the family, despotism, and permissiveness can provoke schizophrenia. These tips are especially useful for those who have a genetic predisposition to mental disorders.