Schizophrenia is a severe mental disorder that alters a patient’s perception of reality. This disease was first described more than 100 years ago, but until now, doctors are still unable to figure out the exact mechanisms of its occurrence. Schizophrenia is prevalent in the modern world – four out of a thousand people are diagnosed with it. Pathology is one of the three diseases that lead to early disability.
Schizophrenia is difficult to treat. A universal cure for it does not exist. Sometimes it takes a long time to find the best medication. Some medications cause severe side effects. When medications with less severe side effects are prescribed, they may not work as well as they should.
The disease is equally common in both sexes. In women, it first appears at a later age, and the prognosis is more favorable. Taking the proper medication helps to achieve sustained remission, during which the symptoms subside entirely and do not affect the patient’s quality of life. Some people with schizophrenia may not manifest themselves after the first incident, with continued use of supportive medications, but the risk of relapse due to psycho-traumatic factors always remains.
What Is Manic Schizophrenia
The pathology can be expressed in different forms, and manic schizophrenia is one of them, for which the impairment of consciousness occurs against a background of manic-depressive psychosis. Doctors have not yet reached a consensus on whether psychosis is the primary symptom of the disease or a secondary mental disorder in its background.
Manic schizophrenia is a condition that simultaneously combines the symptoms of schizophrenia and signs of a mood disorder. Psychotherapists have recognized this type of pathology as an intermediate stage between schizophrenia and bipolar affective personality disorder, which is sometimes mistaken for complicating diagnosis. At the same time, the International Classification of Diseases does not have the disease “manic schizophrenia. There are two codes for it at once: F31 (bipolar affective disorder) and F20 (schizophrenia).
Manic Depressive Psychosis
Manic-depressive psychosis is the obsolete name for bipolar affective disorder. The term “bipolar” means that the disorder’s symptoms manifest themselves in opposite phases—a period of severe and prolonged depression transitions sometime later into an acute manic phase.
Manic-depressive schizophrenia and bipolar affective disorder are different but can develop in parallel. Schizophrenia with manic symptoms is similar to bipolar disorder, but different treatment methods are used.
Manic schizophrenia occurs equally in men and women. However, people who already have relatives with mental disorders are more likely to develop it. Alcoholics and drug addicts with a long history also fall into the risk group.
One of the factors in the development of the disease is stressful situations. But you should know that they can provoke pathology only in people genetically predisposed to mental disorders.
Due to substantial hormonal restructuring of the body, women in the postpartum period are also at risk.
Phase rotation in manic schizophrenia
In general, the disease is characterized by a fluctuating state. A person can be depressed, discouraged (depressive phase), and in a few minutes, start smiling and fall into an excited state (manic phase). Because of this alternation of states is confused with bipolar disorder, which has the same symptoms.
The initial phase of manic schizophrenia is most often depression. It develops rapidly in a few days, escalating from a mild form to a severely depressed state. All the symptoms of the so-called “depressive triad” are present:
- The slowness of speech and thinking;
- Limited or flat affect in the expression of emotions.
The patient has no interest in the surrounding reality, and apathy is pronounced. His speech becomes sluggish, lifeless, loses emotional coloring, and is monotonous. The person prefers to answer monosyllabically or ignores his speech at all. Motor retardation is manifested by slower reaction speed to the action of stimuli, poor facial expressions, and retardation of all movements in general.
Signs of the depressive phase:
- Poor appetite or absence of appetite;
- Melancholy, lethargy, apathy;
- Hypochondriacal manifestations;
- Immobility, which turns into a stupor;
The depressive period can last quite a long time and is reflected in the general psycho-emotional state of the patient. It is not uncommon for obsessive suicidal thoughts to occur.
The second phase, which replaces the depressive phase, is the manic phase, the symptomatology of which is sharply different. The patient during this period is characterized by:
- Active mimicry and gesticulation;
- Emotional agitation;
- Rapid, expressive speech;
- Elevated mood.
Jumps in thoughts characterize the manic phase in the background of schizophrenia – the person shifts abruptly from one topic to another. Such behavior is based on associative chains which are incomprehensible to others if schizophrenia is aggravated by delirium. Quite often, these associations are inconsistent, and speech is too accelerated. However, with proper attention, it becomes apparent that the person’s thinking is coherent, just not ordered.
Manic syndrome is often a result of schizophrenia-related illogical behaviors. A person might wave his hands enthusiastically, run from one corner to the next, sputter incoherently, or display impatience. The central nervous system’s increased mental processes and general emotional excitement can cause this.
The depressive and manic phases succeed each other. The period of depression can last up to several years, but more often, it is about 4-6 months. The agitation phase lasts 1-2 months; in men, it is brighter and can last longer.
There is a certain period of normalization of the mental state between phases, but in a severe course of the disease, it is not expressed significantly. Pathology may take the following forms:
Monopolar – there is only one phase, more often manic, interspersed with a period of stability and then repeating;
Bipolar sequential – a typical clinical picture of the alternating phases of mania and depression;
Bipolar inconsistent – the phases alternate in the following order: manic – stability – manic – depressive – stability, i.e., phases alternate chaotically.
Circular – there is no gap between phases. They replace one another at once.
In the case of schizophrenia with manic syndrome, monopolar or circular forms of affective disorder are observed more often. The latter variant is more complicated since it is more challenging to correct medically.
Common symptoms of manic schizophrenia
Auditory and visual hallucinations are the most conspicuous manifestations of the disorder. Delusions of various content and belief in the influence of certain higher or otherworldly forces are other signs of mental illness.
In this case, a characteristic symptom is pathological cravings: increased sexual cravings, increased appetite, and hypertrophied physical activity. Often there is a disorder of sleep and rest, when the patient may be awake for a long time, showing no signs of fatigue.
Stages of manic schizophrenia
There are several periods in the development of the disease:
- Several periods are distinguished in the development of the disease:
- Prodromal, in which latent signs of the pathology appear;
- Paranoid (manic);
- Kandinsky-Clerambault syndrome;
- Paraphrenic syndrome.
Manic schizophrenia develops gradually. At the initial stage, the following symptoms may be present:
- Loss of interest in the outside world;
- Distrust and suspicion of events and people;
- The rigidity of thinking;
- Sluggishness of reactions, emotional decline.
The initial stage can last from 5 to 10 years, determined by a combination of several factors: the person’s features, the place and conditions of their life, the social environment, attitudes towards them in the family, and others.
During this period, delusions of various contents are strongly pronounced. There can be several of them, but they are united among themselves. The patient feels he is being followed everywhere – on the street, in transport, with “pursuers” exchanging secret signs.
The patient is convinced he is under the supervision of some sects, secret organizations, sorcerers, and aliens. Later developing hallucinations also intersect with previously formed delusions.
The paranoid stage is characterized by the sudden onset of delusions of the “illumination” type. A person experiences a feeling of relief and relaxation as if he managed to solve a complex problem and understand what is happening.
Signs of Kandinsky-Clerambault syndrome
At this stage of manic schizophrenia, severe anxiety, fear, acute panic with ideas of persecution, and auditory hallucinations develop. Often the patient “hears” swearing and obscene shouting in their direction.
Characteristic signs of the disease in Kandinsky-Clerambaut syndrome are various automatisms:
- Motor: the patient believes that all his actions and speech are directed from outside;
- Ideational: the patient believes that all of his emotions, thoughts, and even dreams are put into his head by other people or otherworldly forces;
- Sensory: the person experiences real or imaginary sensations, such as burning, cold, heat, or claims that his body is penetrated by rays from outer space, lasers, and the like.
The patient’s behavior and mood suddenly change from aggressive or irritable to benign and friendly. He tells of acquiring unusual abilities, such as reading other people’s thoughts and influencing them, receiving the miraculous gift of healing from any disease, etc.
During the paraphrenic syndrome, hallucinations occur. The patient “recalls” past events that did not happen while intertwining truth with fiction. He is sincerely convinced that he was forced to forget it, his memory was erased, and now he has had an epiphany.
To the above symptoms are added manic ideas of his greatness. The patient is sure that he has extraordinary power and can dispose of the destinies of the entire planet. There is a confrontation between his associates and enemies in the world. This condition is characterized by the so-called “monologue symptom,” when in response to a question, the patient bursts into a nonstop, incoherent speech, ignoring the attention and reactions of the interlocutor. The topic of the conversation is completely lost.
After a thorough examination, a specialist can make an accurate diagnosis. The procedure involves speaking with patients and collecting information about their medical history. Finally, testing is performed. Sometimes, it takes several months to diagnose the disease accurately.
The diagnosis “schizophrenia with a manic syndrome” is made if the person first had general symptoms of schizophrenic disorder, against which bipolar disorders then developed. Without these signs, only bipolar affective disorder is diagnosed. It is essential for the clinician to correctly distinguish the consistent phase change from the seasonal affective fluctuations characteristic of schizophrenic patients.
Do not hesitate to visit a clinic if you suspect your loved one has a psychotic disorder. The uncontrolled development of the disease leads to the deterioration of his condition. You need to understand that he does not control his behavior during the aggravation phase of manic schizophrenia.
The choice of treatment regimen depends on the type and severity of the illness. The main medications used to control the mental disorder are neuroleptics, which effectively suppress both the symptoms of schizophrenia and manifestations of manic syndrome. They also help to stabilize the condition. However, during the depressive phase, neuroleptics can worsen well-being – during this period, tricyclic antidepressants are usually prescribed.
Atypical antipsychotics have an excellent effect in the vast majority of cases, but their use can provoke a worsening of the condition in some patients.
In addition to medications, psychotherapy is given, allowing the person to become aware of and understand their condition. A comprehensive approach is used to achieve positive dynamics and remission. Treatment can be performed as an outpatient or in the conditions of a specialized clinic – it depends on the patient’s condition.
No universal medication is suitable for all patients, so the therapeutic regimen is selected in several stages. During treatment, the patient must be under the supervision of a doctor.
The goal of manic schizophrenia medication treatment is to achieve a stable remission when the duration of mania and depression phases decreases, and the symptoms disappear over time.
Once the depressive state has been managed, the patient is prescribed constant medication for schizophrenia. At the same time, he needs to undergo regular examinations. Timely monitoring will help not miss the onset of negative dynamics of treatment or the development of side effects from the medications.
No specialist can predict the further development and course of the pathology. It happens that after the first incident, if treatment is started in time, it is possible to achieve a stable remission in the patient. After long-term medication administration, the doctor may prescribe a small maintenance dose, which will reduce the risk of the return of schizophrenia without side effects. Still, it is necessary to remain under constant medical supervision to recognize an exacerbation of the disease in time.