Schizophrenia can occur in many different ways. One type of schizophrenia is called low-grade schizophrenia. A slow course with few signs characterizes it. It can take years to develop, and the patient will not suspect any illness. Psychopathic schizophrenia was previously considered a type of sluggish schizophrenia. Today, however, it is studied as part of schizotypal personality disorders. Let’s find out what its peculiarities are.
Psychopathic schizophrenia is called pseudopsychopathic (less commonly, psychopathic or pseudo schizophrenia). The International Classification of Diseases Revision 9 (ICD-9) includes it under heading 295.5. It was part of a latent (low-progressive or passive) type of schizophrenia. The same disorder was given a new substantiation in ICD-10, as a result of which included in the group of schizotypal personality disorders.
The signs of psychopathic schizophrenia are insufficient for a more severe diagnosis. It occurs in a milder form and is well treated, although it is chronic. It mainly affects a person’s behavior and character but does not lead to personality disintegration. Its main feature is the presence of psychopath-like shades of symptomatology.
It means that the patient’s mood changes sharply, and there are sudden bursts of gratuitous aggression. More complex symptoms, including hallucinations, characterize typical schizophrenia.
The causes of schizophrenia remain unknown to science. Its psychopathic form is no exception. We can only say that it is an endogenous disorder. However, physicians still identify several factors that dispose to the development of pseudopsychopathic schizophrenia. These include:
- Disruption of neurotransmitters in the CNS;
- Brain damage – organic or intoxication;
- Hereditary conditions;
- Genetic mutations.
The disorder is most often identified in adolescent boys. But it is difficult to determine the exact risk groups due to the lack of study of the mechanism of disease formation. Scientists only note that there is no connection between family relationships and upbringing.
The clinical picture is determined by the type of development of psychopathic schizophrenia. The symptoms may vary but can still distinguish typical signs. These include:
- Violence, unmotivated aggression;
- The appearance of strange hobbies;
- Antisocial behavior;
- Breakdown of contacts with relatives and friends;
- Loss of interest in their favorite activities;
- Poor relations with parents;
- Withdrawal, desire for loneliness;
- Grandiose ideas of religious or philosophical content;
- Propensity to use alcohol and drugs.
It is difficult to call the listed symptoms specific. They may indicate a bad upbringing, a problematic character, the influence of asocial personalities, etc.
However, when pseudopsychopathic schizophrenia develops, such changes in behavior are striking, as the person was completely different before. He may grow up in a prosperous family, do well in school, and play sports, but at some point, he begins to change for the worse for no apparent reason. In such cases, it is usually said that the person “seems to have been replaced.
The list of symptoms above shows that psychopathic schizophrenia is not easy to differentiate from other disorders and conditions that may not be associated with psychopathic disorders. To make diagnosis easier, physicians have identified four forms of pseudo-psychopathic schizophrenia. They are called syndromes – hysteroid, increasing schizoidization, epileptoid, and unstable behavior.
The hysteroid form is more often revealed in women who previously had a hysteroid accentuation of character. Such individuals usually crave to be the center of attention. They are characterized by egocentrism, fear of being in an awkward situation, display of behavior, etc. When schizophrenia develops, the following signs can observe:
- Tendency to lie;
- Coldness toward loved ones;
- Mood swings;
- Ridiculous utterances;
These symptoms are especially noticeable against a background of complete well-being. They inevitably cause conflicts with others, including loved ones who do not understand how to further interact with the person.
In boys, the hysteroid syndrome in psychopathic schizophrenia is observed only in 5% of cases.
Hysterical behavior becomes stereotypical. The patient often plays a role without noticing everyone laughing at him.
Increasing schizoidization syndrome
The schizoid type of disorder is characterized by features such as:
- Discontinuity of social contacts;
- Absenteeism from school or work;
- Unusual hobbies;
- The pretentiousness of behavior and appearance.
The patient becomes embittered. He criticizes everything and wants to abstract himself from society; he develops strange hobbies, such as collecting animal feces or nails. He may watch the same movie all day or do unusual physical activities. If reprimanded or prevented from behaving this way, he will snap back. The patient might not know what fascinates him.
Such teenagers often run away from home without any conflict with relatives. An exemplary student may suddenly start drinking alcohol or become addicted to smoking. However, alcoholism and drug addiction in this syndrome rarely develop.
This form of psychopathic-like schizophrenia is the most dangerous for others, as its typical symptom is outbursts of aggression. The main signs are:
- Coldness and cruelty;
- Sudden outbursts of anger;
- Loss of squeamishness;
- Unmotivated attacks on people and animals;
- Eating inedible objects;
- Disorders of a sexual nature;
- Tendency to hypochondria.
Such patients are very suspicious. They do not trust their relatives or the doctor treating them, which makes treatment much more difficult.
The patient is very cruel, and the cruelty is beastly, horrible, and ridiculous. He is either unable to explain the reason for his actions or gives silly arguments.
It is worth noting that this syndrome is not characterized by boiling anger leading to an explosion. The patient is embittered almost constantly.
Unstable Behavior Syndrome
Unstable behavior in pseudo-psychopathic schizophrenia is also more common in men and is characterized by the following features:
- Alcohol and drug abuse;
- Disturbances in sexual behavior;
- Indifference to friends and relatives;
- Constant protests are usually illogical.
The unstable behavior syndrome is similar to the hebephrenic form of schizophrenia and the hybrid syndrome, but no severe destruction of personality is observed. Often such patients, especially teenagers, go home less often, associate with asocial people, drink, smoke, and commit crimes, including those of sexual nature. At the same time, emotional detachment and disinterestedness can be traced in all their actions.
Sexual deviations are especially unusual in this syndrome. They are not limited to the typical features inherent in other psychopathies – transient homosexuality, promiscuity, and early sexual activity. An adolescent with unstable behavior syndrome may urge his mother for intimacy and cohabitation.
Suicidal moods in psychopathic schizophrenia are observed in 41% of patients. In this case, we are talking primarily about adolescents. But often, everything is limited to thoughts. No action is taken. Moreover, many patients don’t even tell anyone about them at the moment of their appearance in the head. They learn about it later, when the attack passes and the adolescent shares his thoughts with doctors.
Patients say they are visited by the idea of entrusting their fate to chance or fate. For example, the teenager stands at the subway station and waits for the train. Suddenly the idea occurs to him to throw himself under the tracks, but he decides he will only do so if there is an even number on the scoreboard.
Sometimes suicidal moods are combined with rigidity to the self and senselessly so. The patient may undress completely, lie down in a snowdrift to freeze, put something heavy on his throat, etc. Often, such attempts to leave life are stopped by relatives or by someone who happens to be nearby.
The disease manifested itself five years ago. During this period, the patient was hospitalized in a psychiatric hospital twice. Each time for 1-2 months. Before that, he demonstrated terrible behavior, annoyed people, by talking about the meaning of life, avoided work, said he was writing a book, and planned to change the world. He was constantly in conflict with his relatives, and in the hospital, he would waltz in and show exaggerated swagger.
Hallucinations and delusions in psychopath-like schizophrenia are absent, which distinguishes it from other forms of schizophrenic disorders.
After treatment with pills, he became collected. He could work at a low-skill job but had a propensity for alcohol, believing that alcohol helps him find inner freedom and relaxation. The likelihood of relapse remained high.
Examination of such disorders is carried out in the presence of a guardian, as patients are often minors.
Subsequently, there will also be individual conversations with a psychologist and psychotherapist. In general, the diagnosis comes down to the following measures:
- Collection of complaints from the patient and those around him.
- Study of medical history from childhood (data on relatives may also be required since the disorder is usually genetically conditioned).
- Physical examination is necessary to rule out CNS and internal organ abnormalities. In addition, the doctor must ensure that there are no needle marks on the patient’s body. It is how drug addiction is ruled out.
- The experimental and psychological examination includes all kinds of tests.
- Clinical and laboratory diagnostics (tests, MRI, CT scan, EEG, ECG, etc.).
If necessary, specialists of related professions are involved.
Treatment is selected individually. It is possible to treat symptoms of anxiety or aggression with drugs – neuroleptics, antidepressants, tranquilizers, and normotimics. Psychotherapeutic sessions – individual and group – are crucial. At first, the patient is placed in remission and then taught to live so that the attack will not happen again.
If the course of the disorder is mild, most treatment is performed on an outpatient basis. If the patient is a danger to himself or others, he is left as an inpatient. While the patient is being treated, his relatives are consulted by a psychiatrist. They will have to learn how to communicate appropriately with someone with a mental disorder. Above all, they need to recognize that their loved one is ill and not just “lost” or “mixed up with the wrong company.
The disease has a chronic course, but in most cases, the prognosis is favorable. During the remission period, the person returns to everyday life. Outwardly, including in behavior, he will not differ from the rest. He will have to prevent and adhere to the psychiatrist’s recommendations.
The first thing to do is to give up alcohol and other psychoactive substances. If necessary, it is necessary to take medications in the dosage that the doctor has determined. At the first sign of a flare-up, it is worth seeing a doctor immediately and not waiting until the patient needs to be forcibly hospitalized again.