Schizophrenia is often confused with other disorders and syndromes. It is connected with the similarity of signs in different mental diseases and many forms and varieties of diseases of the schizophrenic spectrum. Most of them are heavily treated and have an aggressive course. However, there are also less dangerous types. One of them is neurosis-like schizophrenia. Let’s take a closer look at its features.
Neurosis-like schizophrenia is also called pseudoneurotic and schizoneurosis. The term was coined by scientists Paul Hoch and Philip Polatin in the 1940s. The name is due to the similarity of this pathology to neurotic disorders. For a long time, this diagnosis was not made. As a rule, an illness with similar symptoms was considered sluggish or low-progressive schizophrenia.
According to the International Classification of Diseases, 10th revision, neurosis-like schizophrenia is a subtype of schizotypal disorder and is included in F21.3. The basic symptoms are obsessions, compulsions, phobias, and hypochondria. Therefore, it is often confused with OCD and other neurotic conditions. The disease has a similar onset. To determine the diagnosis, the following criteria help:
- Neurosis occurs after a strong emotional shock, and schizophrenia manifests itself for no apparent reason.
- Neurotic patients understand that they are ill and want to eliminate the symptoms that prevent them from living to the fullest. People with schizophrenia deny that they have the disease. As a rule, they are brought to the clinic by relatives.
- Neurosis does not cause personality disintegration. After treatment, the person becomes the same person they have always been. Schizophrenia leaves an indelible mark, though not always serious, on the individual’s personality, affecting their “self.”
- It can cure neurosis completely. Schizoneurosis is well treated, but the diagnosis remains for life. The risk of relapse is quite high.
The main difference between the pseudoneurotic form of schizophrenia and its other types is the ease of course. Its symptoms are not as intense as, for example, paranoid disorder. A person diagnosed with this disorder can lead a decent life if the outcome is favourable (probably quite high).
The question of the causes of any form of schizophrenia remains open, although the disease has been studied for centuries. Scientists have made great advances in studying the brain, but today it is only 4-5% studied. When we talk about schizophrenia, regardless of its variety, we don’t mean causes but risk factors. These include:
- Genetics. If parents, grandparents, aunts, uncles, or other relatives had mental disorders, the likelihood of their offspring developing them increases.
- Spontaneous genome mutations of unclear aetiology occur both during fetal development and after birth.
- Disruption of brain neurotransmitters, including serotonin, binds neurons.
- Adverse social and psychological factors, including trauma, violence, oppressive parenting, etc.
Often, neurosis-like schizophrenia manifests at a young age, under 35. The earlier its first signs appear, the heavier its treatment and the more dangerous its complications.
Symptoms of neurosis-like schizophrenia occur spontaneously, so it is difficult to relate the manifestation of the disease to any specific situation. The clinical picture can be ambiguous. In general, there are several groups of signs related to behaviour, psycho-emotional background, sensorimotor, and thinking of the patient. Behavioural symptoms include:
- Compulsive thoughts of high intensity – obsessions, forcing to perform certain actions or rituals – compulsions: patients wash their hands long and often, count to 10 before opening the door, unplug all electrical appliances, double-check whether the front door lock is closed, etc.
- Alienation, withdrawal from society, narrowing of social circle. The patient makes contact more out of necessity, for example, for work than out of desire. This sign is especially striking when the person is normally pleasant.
- Change of speech manner, use of strange phrases, overly abstract metaphors, understandable only to the patient himself.
- They are wearing unusual clothes. A person suddenly changes style and begins to wear bright, flashy, and provocative things.
- They are ignoring conventions. Patients with schizophrenia do not follow the rules of etiquette, and the opinions of others, including remarks, become unimportant to them.
- Food rejection often leads to severe weight loss and even anorexia. Also, such patients often adhere to strange diets that they did not previously observe.
- Asthenia. The patient is quickly exhausted, gets tired after a little work, and takes a long time to recover.
See Also: How is OCD different from schizophrenia?
Psycho-emotional and neurotic manifestations of neurosis-like schizophrenia include:
- Mood swings for no apparent reason;
- Anxiety, especially among a large number of people;
- A tendency to reflection and “self-digestion”;
- Inadequacy of emotions;
- Phobias of strange contents (fear of the letter “o”);
- Hypochondria – obsessive fear of getting sick.
Sometimes the obsessions, compulsions, and phobias become so strong that the patient can no longer tolerate them. He begins to have thoughts of death and suicide.
In a state of aggravation, anhedonia develops – the inability to enjoy pleasure.
Signs associated with sensorimotor perception:
- Derealization – is a perceptual disorder in which the world around a person seems unreal, separated, and devoid of colours. Sometimes it is perceived as shadows or objects in a fog.
- Depersonalization – a disorder of self-perception estrangement from mental properties of one’s personality. It is characterized by the absence of thoughts in the head, feelings, emotions, or character traits. Some patients feel that they have lost weight, voice, or become smaller in stature.
- Dysmorphia is the belief that one has physical defects (small penis, large nose, etc.). There may not be any defects, but this does not embarrass the patients. They are convinced that they are ugly.
To hide their “flaws,” the person wears wide clothes, covers the face with a hood, puts on makeup, or signs up for plastic surgery. Anorexia or bulimia can develop against a background of disgust with his body.
Another group of signs of neurosis-like schizophrenia is connected with thinking. The following disorders can be observed:
- The poor concentration of attention;
- Impaired memory;
- Cognitive impairment;
- Inability to adequately evaluate his behaviour.
All of the above signs, including obsessions, phobias, hypochondria, and compulsions, affect thinking, which becomes pathological. The patient cannot comprehend the depth of the problem he is facing.
Diagnosis and Treatment
During the initial diagnosis, the doctor examines the patient and talks to them. May then interview Relatives. The psychiatrist needs to see the picture from different angles, not just from the words of the patient, who may be inadequate during an exacerbation. It is also necessary to determine whether the person has a genetic predisposition to such disorders. It is found whether there were schizophrenics and mentally ill people in the family.
Diagnosis includes standard laboratory and instrumental procedures, including MRI, CT, EEG, tests, etc. Various psychotherapeutic tests are also prescribed. To accurately make a diagnosis, it is necessary to differentiate it from similar disorders. It may require months of observation of the patient.
Treatment is based on psycho- and drug therapy. The patient attends individual and group sessions with a psychiatrist and takes antipsychotic medications. The patient’s condition determines the dosage and type of medication. Usually, atypical neuroleptics are prescribed. The patient’s relatives also come to the psychotherapist for consultation, who will have to learn how to interact with the person with schizophrenia.
Often neurosis-like schizophrenia does not cause severe personality damage or disintegration. It is well-treatable. But the prognosis is largely determined by the patient’s behaviour. The patient must lead a healthy lifestyle and take preventive measures. Otherwise, relapse is unavoidable. Inpatient treatment and long-term hospitalization are rarely necessary.