Schizophrenia takes many forms. This is one of the most complex diseases in psychiatry, the exact causes of which are almost impossible to establish. It can develop over decades or lead to hospitalization in a matter of weeks. Sluggish schizophrenia, or low progression, belongs to the first type. It progresses slowly and imperceptibly for the patient, which often leads to too late detection of the disease. In the article, we will consider the main signs, causes, forms, and methods of treatment of sluggish schizophrenia.
In Europe, schizophrenia is diagnosed in 370 patients per 100,000 inhabitants of the country. On average, this is from 0.5 to 1% of the entire population. The sluggish form is observed in approximately 16.9-20.4% of all schizophrenic patients. Moreover, it is often detected in the later stages, since at the initial stages it is accompanied by a small number of unexpressed symptoms.
In the final stage, the disease rarely leads to serious consequences. Most often, complications such as affective disorders, obsessive-compulsive disorder, phobias, compulsive behavior, neurosis, etc. are observed.
In ICD 10, there is no such pathology as sluggish schizophrenia. It is usually included in the group of schizotypal disorders (F21). However, it has been studied for a very long time. The first data about it appeared in the works of E. Bleiler in 1896, who called it “a mild form of hebephrenia.” In 1902 V.P. Serbian, describing the symptoms of schizophrenia, which today is called sluggish, used the wording “sluggish dementia praecox”.
In 1933, this form of the disease began to be used in the differential diagnosis of childhood schizophrenia. In particular, the Soviet psychiatrist G.E. Sukharev. Only in 1955 R.A. Nadzharova described the symptoms of sluggish schizophrenia under this name. In 1969, her work was supplemented by Professor A.V. Snezhnevsky.
After that, the described disease began to be used as a full-fledged diagnosis. Today, psychiatrists, based on a specific case, use the names “sluggish schizophrenia” or “schizotypal disorder” to describe the pathology.
Cause of the Sluggish Schizophrenia
The main cause of any form of schizophrenia is a violation in the brain when there is an incorrect exchange of neurotransmitters that provide connections between neurons – brain cells. There are many factors that can provoke such violations.
Usually, we are talking about heredity. However, a genetic predisposition cannot fully explain this pathology, since 10% of patients do not have people with mental disorders in their family. Other contributing factors include:
- Improper development of the embryo may be the result of trauma to the mother or her unhealthy lifestyle during pregnancy.
- Problems in education. The likelihood of psychosis increases if the child is brought up in conditions of permissiveness or, on the contrary, despotism. Doctors say that today the number of patients with schizophrenia has increased, to whom mothers did not pay due attention in childhood.
- Shock situations. Often they become the impetus for the development of the disease, especially in the presence of a genetic predisposition. We are talking about violence, including sexual violence, dismissal from work, expulsion from the university, betrayal of a spouse, etc.
- Age crises. Basically, schizophrenia manifests itself either in childhood or at the age of 25-35 years. In these intervals, crises are possibly associated with the beginning of adulthood, with the need to leave the parental home or build your own family.
- Alcoholism and drug addiction. Regular consumption of psychoactive substances negatively affects many parts of the brain. Schizophrenia can also be a consequence of such addictions.
These are the main factors. Also, mechanical injuries can lead to disorders in the brain. In the clinical practice of psychiatrists, there are cases when the signs of schizophrenia began to appear 5 or even 10 years after the injury.
Sluggish schizophrenia can be continuous and paroxysmal. But often the first type of pathology occurs, which goes through three stages of development:
- Latent. The symptoms are mild, and therefore invisible to the relatives of the patient, who does not consider himself sick and does not feel. However, he refuses to communicate with people, leave the house, and go to school or work. Often there is nervous overexcitation or depression. The disease usually begins in adolescence. More striking signs appear after a few years.
- Active. Symptoms become pronounced. People around begin to notice that something “strange” is happening to a person. He often panics, is afraid of everything, and worries for no reason. Delusions and hallucinations are absent.
- Weakened. The patient’s condition returns to normal. There is a period of calm, which can last for decades.
It is difficult to identify pathology at the initial stage, which leads to its progression and unpredictability of the final result.
Symptoms of Sluggish Schizophrenia
Symptoms and signs of sluggish schizophrenia are determined by its stage and form. But there are also common manifestations that are characteristic of almost every case. First, a person becomes less active, his interests disappear, and his social circle narrows. In his behavior, people notice foolishness and eccentricity. Speech becomes pretentious and demonstrative.
Only after a few years can an exacerbation occur, during which patients complain of anxiety and unreasonable fears. They have obsessive thoughts that lead to depression.
The following signs are observed:
- Paranoid state (presence of delirium);
- Sudden change of mood;
- Fictional stories;
- Constant fatigue;
- Fast fatiguability.
In such cases, a change in behavior is striking. His family and friends are starting to notice him. However, there are no typical symptoms of schizophrenia, such as persecution or hallucinations.
Gradually, the symptoms weaken and disappear. There comes a period of stabilization or remission, which can also last for several years. Then the signs will return, and in an even more pronounced form. The disease progresses progressively. Each acute phase is accompanied by an increasing set of symptoms.
To make a diagnosis, at least 4 signs from the following list must be observed:
- Emotions, inadequate situations;
- Eccentric behavior, eccentricity;
- Desire to get away from contact with people;
- Strange conclusions and reasoning;
- Obsessive thoughts, including those of a sexual nature;
- Problems with personal hygiene and appearance;
- Illusory bodily sensations;
- Sudden interest in mystical and religious teachings;
The presence of 4 symptoms in a person should be the reason for a visit to a psychotherapist. In this case, measures should be taken by the relatives of the patient.
Modification of symptoms
Sluggish schizophrenia is characterized by a gradual modification of symptoms. Periodically, new signs appear:
- Extreme instability of mood;
- Very fast fatigue;
- Apathy and depression;
- Anhedonia (inability to have pleasure);
- Lack of initiative, alienation;
- Senestopathies (painful sensations in the body).
Some patients have synesthesias when ordinary things are endowed with unusual properties. So, for example, a color acquires a smell, and a sound acquires a color, and so on. Patients complain that they cannot concentrate on work, their thoughts are confused, and the thought process is constantly interrupted.
The patient is unable to assess his condition. He does not understand why people around him react so strangely to him and avoid him.
Asthenic symptoms persist even during the period of stabilization. As soon as a person does something, he immediately gets tired and loses interest in the work he has begun. However, in general, professional skills are preserved. If the patient does not yet own them, then he can still learn something, albeit with difficulty.
There is such a thing as “axial symptomatology”, which is another distinguishing feature of sluggish schizophrenia. Axial symptoms include phobias, obsessions, and ideas. The patient has inadequate beliefs that he cannot logically substantiate.
He also has fears, and hypochondria develops. Ritual movements are observed when he often double-checks everything, for example, whether all electrical appliances are turned off from the network. In part, these symptoms resemble those of obsessive-compulsive disorder (OCD).
Signs in men and women
In men, symptoms appear earlier. At first, he becomes cold and aloof and begins to hostilely treat others, including those who love him. He often breaks down on loved ones and is rude to everyone for no reason.
All this is happening against a backdrop of apathy and inactivity. He suddenly loses interest in his favorite hobby, work, or study. Even what used to bring great pleasure becomes uninteresting. The appearance of the patient also changes. He stops shaving, washes less often, and wears wrinkled and dirty clothes. Sometimes he breaks off all contact and withdraws into himself, preferring the inner world to the outer one.
In women, sluggish schizophrenia usually manifests itself at the age of 20-30 years. The signs are about the same as in men – fears, obsessions, and rituals. And the latter can be very unusual. For example, the patient does not dare to enter the door until she has counted to 15. There are times when patients do not sit on a chair until they have walked around it several times. The problem is that the woman is not aware of the absurdity of such actions.
Signs in children and adolescents
Sluggish schizophrenia can develop in children, and even at the age of 7. The first signs are causeless fears and conversations with invisible interlocutors. Later, the following symptoms appear:
- Paranoia. The child believes that everyone, including relatives, wants to offend him.
- Fears. Even an ordinary situation or object can cause panic and fear. And over time, they become more and more.
- Insulation. The kid loses interest in friends, books, cartoons, and toys.
- Capriciousness. The mood in children with low-progressive schizophrenia changes very often, it is almost impossible to please them.
- Speech disorders. The child formulates thoughts poorly, and cannot logically argue certain judgments. Sometimes they just say phrases that are not related to the topic of conversation.
The impetus for the development of sluggish schizophrenia in childhood can be the period of puberty, which begins at 11-12 years. The teenager becomes very emotional, he develops a tendency to depression and suicidal thoughts. It is possible that he will debut schizophrenia.
The following signs should be observed:
- Changes in speech. The patient speaks inappropriate phrases, gets confused, gets confused, and cannot logically construct a thought.
- Deterioration in performance. Pathology begins to interfere with normal learning. It is difficult for a teenager to concentrate and solve a problem. He takes on one thing, then another, without completing them.
- Communication problems. The teenager does not make contact, refuses to make friends, and does not look into the eyes during a conversation.
Some of these signs can also be observed in healthy people. But when there are a lot of symptoms, it becomes dangerous to ignore them. You should at least consult a psychologist.
The child may find new and strange hobbies and often gets angry when he is prevented from doing something, even if it is completely absurd.
The behavior of a child with sluggish schizophrenia must seem strange to parents. If you see that he is beginning to be interested in religious teachings and is trying to clearly follow some rules, and this is not customary in your family, talk to a specialist. Do not try to explain everything through the pressure at school and the impact on the child of the Internet.
Sluggish schizophrenia is a general name for several types of disorders and syndromes, each with its own symptoms. If the disease develops in a simple form, then the patient has asthenia, emotional coldness, and apathy. However, other manifestations are also possible, in particular, obsessive-phobic, hysterical, depersonalization, etc. Let us examine some of them.
Obsessive Phobic Disorder
In this disorder, which can develop as part of indolent schizophrenia, there are frequent and intense panic attacks, interspersed with short remissions. A person has many rituals, and they become more and more complicated.
It all starts with checks – are the doors closed, are the appliances turned off, etc. As the pathology progresses, the patient cannot perform almost any action without rituals. This prevents him from fully contacting the society. He moves away from him, goes out less often, and does not even communicate with his relatives.
In addition to obsessions, phobias develop. As a rule, they are associated with the fear of external threats. The patient is afraid of people, persecution, bacteria, viruses, sharp objects, fire, etc. In this regard, the rituals are becoming more and more. So a person tries to protect himself from threats, for example, he often washes his hands, does not touch the tap valve or door handle after washing them, etc. A well-known patient with this disorder is Howard Hughes, played by Leonardo DiCaprio in The Aviator.
In addition, patients with obsessive-phobic symptoms develop obsessions. They show up with the following symptoms:
- Constant wisdom;
- Emotional poverty;
- Conducting unnecessary disputes;
- Deep insight into meaningless judgments;
- Repeating the same operations in the same order.
At night, a person is disturbed by insomnia. During the day he looks tired. But sometimes fatigue is replaced by excitement. Further development of the disorder leads to stereotypy. All rituals are performed automatically. Sometimes patients begin to harm themselves, for example, combing their hands until they bleed while washing.
They are also called neurosis-like disorders, which often develop in low-grade schizophrenia. In this case, there is a dominance of anxiety and phobias. Panic attacks occur frequently, but they are atypical and very protracted. Often patients complain that they lose control over their actions and thoughts. There is a fear of becoming crazy. Synesthesias and senestopathies are also of concern.
In some cases, patients are afraid of harming themselves or their loved ones. At the same time, anxiety can be accompanied by vivid images of a future tragedy. There is a fear of death and suicide.
The sluggish form of schizophrenia with depersonalization includes the following symptoms:
- Decrease in intelligence;
- Lack of initiative.
Patients begin to carefully monitor themselves. At the same time, the outside world becomes less bright and interesting. There is dysthymia, in which a person is very sad and angry at the same time. The main thing is that he moves away from reality, ceases to identify himself with society, and loses his own “I”.
With tantrums, a person behaves too defiantly, the symptoms are somewhat grotesque and exaggerated. He becomes rude and uncompromising. In some cases, mannerisms, and a tendency to demonstrativeness appear in behavior. Other signs include:
- Aphonia (lack of voice, speaks in a whisper);
- Hyperkinesis – involuntary movements;
- Contracture – the inability to straighten or bend the joint;
- Obsessive urges;
- Flashy appearance.
Hysterical manifestations are paroxysmal in nature, and the attacks last from 3 to 8 months. Sometimes there is a paroxysm, stupor, or overexcitation. Possible pseudo-hallucinations. The patient constantly lies, does not think about the consequences of his actions, and becomes prone to deviation and vagrancy.
Before the formation of schizophrenia (this stage is called a premorbid state), a person may experience impressionability, a very vivid imagination, lack of stress tolerance, isolation, sensitivity to conflicts, indifference to loved ones, emotional instability, etc. All this can serve as a reason for a visit to a psychologist.
Suicidal attempts are possible. If they occurred, be sure to tell the doctor about it, even if it was a long time ago.
Various factors can provoke such symptoms. In childhood, this happens due to the death of a parent, divorce of spouses, moving to a new city, changing schools, etc. During this period, the child may start smoking, drinking, and taking drugs. In a state of intoxication, he behaves excessively aggressively. Such behavior can lead to problems with the law.
Diagnostics of Sluggish Schizophrenia
The problem of sluggish schizophrenia is that, due to the progression and lack of expression of signs, it is difficult to identify it at the latent stage. As a result, people go to the doctor already when the symptoms are clear. In this case, only the diagnosis can take several months, during which the patient is monitored by various specialists.
It is important to carry out a differential diagnosis since schizophrenia can be progressive, chronic, acute, paranoid, etc. The treatment and the future of the patient depend on the accuracy of the diagnosis.
Conversations are held not only with him but also with relatives. Moreover, the psychiatrist first tries to find out if the patient had people with mental disorders in his family, and then teaches them how to interact with the schizophrenic correctly.
Also, the patient undergoes various procedures:
- Duplex scanning;
- Psychological tests;
Doctors need to make sure that there are no functional disorders in the brain. Tests confirm or refute a particular diagnosis. But most of the time the patient spends conversations with a psychiatrist or psychotherapist. Medicines can be prescribed at the very beginning of the examination, but not strong ones. Subsequently, complex therapy is being developed.
Treatment of Sluggish Schizophrenia
Treatment can be carried out both on an outpatient basis and in a hospital. This is decided by the doctor after the diagnosis. The therapy consists of the following components:
- Taking medications – neuroleptics, tranquilizers, etc. The course is selected individually.
- Psychotherapeutic sessions are aimed at correcting a person’s behavior and increasing his self-esteem. He needs to be aware of the disease. This will help to restore efficiency and establish relationships with others.
- Briefing – the patient and his family are instructed regarding the period of remission. Experts explain how to prevent future attacks. Also, the patient’s relatives learn about those symptoms, when they appear, they urgently need to take the person to the clinic.
Communication with doctors after treatment is not interrupted. It is impossible to completely cure schizophrenia, although sometimes it is possible to achieve a lasting effect when the symptoms stop for a long time (or even until the end of life).
Sluggish Schizophrenia Prevention
To prevent the progression of the disease, the patient must engage in prevention. First of all, you should eliminate bad habits and streamline your life. In general, doctors advise to adhere to the following rules:
- Observe the daily routine – get up early, get enough sleep, eat on time, and walk daily in the fresh air.
- Engage in physical education – do exercises, ride a bike or ski, and go to the pool.
- Eliminate stress – you should avoid conflicts and stressful situations, and limit communication with people who provoke disputes.
- Eat right – give up alcohol, coffee, strong tea, and spicy and fatty foods, including foods with vitamins and minerals in your diet.
- Visiting doctors – regularly come to talk with a psychotherapist or psychologist, especially during periods of breakdown and bad mood.
Schizophrenia is not a sentence. With this diagnosis, you can lead a comfortable life at a quality level. But for this, you will have to work on yourself, your behavior, and your daily routine. If everything is done according to the doctor’s instructions, then the likelihood of relapse is reduced. However, no specialist will give a 100% prognosis, since schizophrenia, including a sluggish one, is a very unpredictable pathology.