Schizophrenia takes many forms. It is one of the most complex illnesses in psychiatry, the exact causes of which are almost impossible to determine. It can develop over decades or lead to hospitalization in weeks. Sluggish schizophrenia, or low-growth schizophrenia, is the first type. It progresses slowly and unnoticed by the patient, which often leads to too late detection of the disease. This article discusses the main signs, causes, forms, and treatment options for low-grade schizophrenia.

Sluggish Schizophrenia

Features

Worldwide, 370 patients per 100,000 inhabitants are diagnosed with schizophrenia. Average, this represents from 0.5 to 1% of the entire population. The sluggish form is observed in about 16.9-20.4% of all schizophrenic patients. And often, it is revealed at late stages since at initial stages it is accompanied by a low quantity of not expressed symptoms.

In the final stage, the disease rarely leads to severe consequences. More often, complications such as affective disorders, obsessive-compulsive disorder, phobias, compulsive behavior, neurosis, etc., are observed.

There is no such pathology as sluggish schizophrenia in ICD 10. Usually, it is included in the group of schizotypal disorders (F21). At the same time, it has been studied for a long time. The first data on it appeared in the works of E. Bleuler in 1896, who called it “a mild form of hebephrenia.” In 1902 V.P. Serbsky, describing the symptoms of schizophrenia, which today is called sluggish, used the wording “sluggish early dementia.”

In 1933, this form of the disease began to be used in the differential diagnosis of childhood types of schizophrenia. In particular, the Soviet psychiatrist G.E. Sukhareva was engaged in such practice. Only in 1955 R.A. Najarova describes the symptomatology of sluggish schizophrenia under this very name. In 1969 his work was published by Professor A.V. is filled by

After that, the disease described began to be used as a full-fledged diagnosis. Today, psychiatrists, on a case-by-case basis, use the names “sluggish schizophrenia” or “schizotypal disorder” to describe the pathology.

Causes

The leading cause of schizophrenia is a disorder in the brain when an improper exchange of neurotransmitters provides connections between neurons – brain cells. Many factors can provoke such disorders.

It is usually a question of heredity. However, genetic predisposition cannot fully explain this pathology since 10% of patients do not have people with mental disorders in their families. Other provoking factors include:

  • Abnormal embryo development can result from injuries to the mother or her unhealthy lifestyle during pregnancy.
  • Problems in upbringing. The likelihood of psychosis increases if the child is raised in an environment of permissiveness or despotism. Physicians claim that today there is an increase in the number of schizophrenic patients neglected by their mothers during childhood.
  • Shocks. Often they trigger the disease’s development, especially in the presence of a genetic predisposition. We are discussing sexual violence, dismissal from work, expulsion from the university, cheating on a spouse, etc.
  • Age crises. Schizophrenia mainly manifests in childhood or at the age of 25-35. In these intervals, crises may be connected with the beginning of adult life, with the necessity of leaving the parental home or building 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. Mechanical trauma can also lead to abnormalities in the brain. In the clinical practice of psychiatrists, there are cases where signs of schizophrenia began to appear five or even ten years after the trauma.

Stages

Sluggish schizophrenia can be continuous and seizure-like. But often, there is the first type of pathology, which has three stages of development:

  • Latent. Symptoms are poorly expressed and therefore unnoticed by the relatives of the patient, who do not consider or feel ill. However, he refuses to communicate with people, leave the house, and go to school or work. Often there is nervous overexcitement or depression. The disease usually begins in adolescence. More vivid signs appear several years later.
  • Active. Symptoms become pronounced. People around him begin to notice something “strange” happening to the 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. A quiescence period sets in, lasting for dozens of years.

It is difficult to detect the pathology at the initial stage, which leads to its progression and unpredictability of the final result.

Symptoms

Its stage and form determine the symptoms and signs of sluggish schizophrenia. But there are also general manifestations characteristic of almost every case. At first, the person becomes less active, his interests disappear, and his circle of communication narrows. In his behavior, people notice his goofiness and eccentricity. Speech becomes pretentious and demonstrative.

A relapse can occur only after a few years, during which patients complain of anxiety and unreasonable fears. They have intrusive thoughts, leading to a depressive state.

The following signs are observed:

  • Paranoia (presence of delusions);
  • Phobias;
  • Abrupt change of moods;
  • Fabricated stories;
  • Constant fatigue;
  • Rapid fatigue.

In such cases, the behavior change is striking to the eye. His family and friends begin to notice him. However, there are no typical symptoms of schizophrenia, such as persecution mania or hallucinations.

Gradually the symptoms subside and disappear. There is a period of stabilization or remission that can last several years. Then the symptoms return in an even more pronounced form. The progression of the disease is gradual. Each acute phase is accompanied by a greater and greater range of symptoms.

To make a diagnosis, at least four of the following symptoms must be present:

  • Emotions are inadequate for the situation;
  • Bizarre behavior, eccentricity;
  • Desire to avoid contact with people;
  • Bizarre 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;
  • Depersonalization.

The presence of four symptoms in a person should be cause for a visit to a psychotherapist. In this case, measures should be taken by the patient’s relatives.

Modification of symptoms

The gradual modification of symptoms characterizes sluggish schizophrenia. From time to time, new symptoms appear:

  • Extreme instability of mood;
  • Very rapid fatigability;
  • Apathy and depression;
  • Anhedonia (inability to take pleasure);
  • Lack of initiative, aloofness;
  • Senestopathies (heavy sensations in the body).

Some patients have synaesthesias, in which ordinary phenomena are given unusual properties. For example, color takes on a smell, sound takes on a color, etc. Patients complain that they cannot concentrate on their work, their thoughts become 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 and avoid him.

Asthenic symptoms persist even during a period of stabilization. As soon as the person does something, they immediately get tired and lose interest in the task. However, on the whole, professional skills are retained. If the patient does not yet master them, he can still learn something, albeit with difficulty.

Productive symptoms

Such a concept as “axial symptomatology” is another distinctive feature of sluggish schizophrenia. Axial symptoms include phobias, obsessive actions, and ideas. The patient develops inadequate beliefs which he cannot justify logically.

He also has fears and develops hypochondria. Ritualistic movements are observed when he often double-checks everything, for example, whether all electrical appliances are unplugged. This symptomatology partially resembles the signs of obsessive-compulsive disorder (OCD).

Signs in men and women

In men, the signs appear earlier. At first, he becomes cold and aloof and dislikes those around him, including those who love him. He often snapped at loved ones, rude to everyone for no reason.

All this occurs against a background of apathy and inactivity. He suddenly loses interest in his favorite hobby, work, or studies. Even things that used to bring great pleasure became 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.

In women, flaccid schizophrenia usually manifests itself at 20-30. 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 go through the door until she counts 15. There are cases when patients do not sit down in a chair until they have walked around it several times. The problem is that the woman does not realize the absurdity of such actions.

Signs in children and adolescents

Sluggish schizophrenia can develop in children, even at the age of 7. The first signs are unreasonable fears and talking to invisible interlocutors. Later on, the following symptoms appear:

  • Paranoia. The child believes everyone, including relatives, wants to hurt them.
  • Fears. Even an ordinary situation or object can cause panic anxiety. And over time, there are more and more of them.
  • Isolation. The child loses interest in friends, books, cartoons, and toys.
  • Capriciousness. The mood of children with low-progressive schizophrenia changes very often; it is almost impossible to please them.
  • Speech disorders. The child does not formulate thoughts well and cannot logically argue these or those judgments. Sometimes they simply speak phrases that are not connected with the subject of conversation.

A trigger for the development of low-grade schizophrenia in childhood may be the period of puberty, which begins at age 11 or 12. The teenager becomes very emotional and has depression and suicidal tendencies.

See Also: What is Neurosis-Like Schizophrenia?

The following signs should be observed:

  • Changes in speech. The patient speaks inappropriate phrases, is confused, and cannot think logically.
  • Deterioration in academic performance. Pathology begins to interfere with regular learning. It is difficult for teenagers to concentrate and solve a problem. He takes one task at a time, then another, without completing them.
  • Problems with communication. The teenager does not come into contact, refuses to make friends, and does not look in the eyes during conversations.

Some of these signs can also occur in healthy people. But when symptoms accumulate in large numbers, it becomes dangerous to ignore them. Then a psychologist should be consulted.

A child can find a new and strange hobby and often gets angry when he is prevented from doing something, even if it is completely absurd.

The behavior of a child with flaccid schizophrenia must seem strange to parents. Talk to a specialist if you see him becoming interested in religious teachings and trying to follow some rules that are not accepted in your family. Don’t try to explain everything with the school workload and the influence of the Internet on the child.

Types

Sluggish schizophrenia is a general name for several disorders and syndromes, each characterized by different symptoms. If the illness develops in a simple form, the patient will have asthenia, emotional coldness, and apathy. However, other manifestations are also possible – obsessive-phobic, hysterical, depersonalizing, etc. Let’s look at some of them.

Obsessive-phobic disorder

In this disorder, which can develop as part of flaccid schizophrenia, there are frequent and intense panic attacks, interspersed with brief remissions. The person develops a variety of rituals, and they become more and more complicated.

It begins with checks – whether doors are closed, appliances turned off, etc. As the pathology progresses, the patient cannot perform almost any action without rituals. This prevents him from having complete contact with society. He distances himself from it, goes out less often, and does not communicate even with his loved ones.

See Also: What is Recurrent Schizophrenia?

In addition to obsessions, phobias develop. As a rule, they are connected with the fear of external threats. The patient fears people, persecution, bacteria, viruses, sharp objects, fire, etc. In connection with this, rituals become more and more numerous. So the person tries to protect himself from threats, for example, often washing his hands, does not touch the faucet valve or door handle after washing them, etc. Howard Hughes, a well-known patient with this disorder, is played by Leonardo DiCaprio in “The Aviator.”

In addition, patients with obsessive-phobic signs develop obsessions. They manifest themselves in the following symptoms:

  • Constant punditry;
  • Emotional paucity;
  • Engaging in unnecessary arguments;
  • Deep delving into nonsensical 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 agitation. Further development of the disorder leads to stereotypy. All rituals are performed automatically. Sometimes patients begin to harm themselves, for example, scratching their hands until they bleed while washing.

Anxiety-phobic symptoms

They are also called neurosis-like disorders, which often develop in flaccid schizophrenia. In this case, there is a domination of anxiety and phobias. Panic attacks occur frequently, but they are atypical and very prolonged. Often patients complain that they lose control of their actions and thoughts. Fear of becoming insane emerges. Synaesthesias and senestopathies are also disturbing.

In some cases, patients are afraid of harming themselves or their relatives. Vivid images of future tragedies can accompany this anxiety. Fear of death and suicide arises.

Depersonalization

The sluggish form of schizophrenia with depersonalization includes the following symptoms:

  • Alienation;
  • Diminished intellect;
  • Anhedonia;
  • Lack of initiative.

Patients begin to observe themselves. At the same time, the outside world becomes less bright and exciting. Dysthymia is observed, in which the person is unfortunate and angry simultaneously. Most importantly, he withdraws from reality, stops identifying with society, and loses himself.

Hysterical symptoms

In hysterics, the person behaves too defiantly; the symptoms are somewhat grotesque and exaggerated. He becomes rude and uncompromising. In some cases, there is an affectation in behavior, a tendency to be demonstrative. Other signs include:

  • Aphonia (no voice, speaks in a whisper);
  • Hyperkinesis – involuntary movements;
  • Contracture – inability to bend or unbend a joint;
  • Obsessive compulsions;
  • Conspicuous appearance.

Hysterical manifestations have a seizure-like character, with seizures lasting from 3 to 8 months. Sometimes paroxysms, stupor, or overexcitation are observed. Pseudo-hallucinations may occur. The patient lies constantly, does not think about the consequences of his actions, and becomes prone to deviation and vagrancy.

Predisposing symptoms

Before schizophrenia is formed (this stage is called the premorbid state), a person may have impressionability, a vivid imagination, lack of stress tolerance, withdrawal, sensitivity to conflict, indifference to loved ones, emotional instability, and so forth. All of this may be cause for a visit to a psychologist.

Suicide attempts are possible. If they have occurred, be sure to tell your doctor, even if it was a long time ago.

Various factors can provoke such symptoms. In childhood, it happens because of the death of a parent, divorce, moving to a new city, a change of school, etc. During this period, the child may start smoking, drinking, and taking drugs. When intoxicated, they behave excessively aggressively. Such behavior can lead to problems with the law.

Diagnosis

The problem with sluggish schizophrenia is that it is difficult to detect in its latent stage due to its grotesqueness and lack of symptoms. As a result, people go to a doctor when symptoms are apparent. At the same time, it may take several months to diagnose, during which time various specialists observe the patient.

It is essential to make a differential diagnosis since schizophrenia can be progredient, chronic, acute, paranoid, etc. Treatment and the patient’s future depend on the accuracy of the diagnosis.

Talks are conducted not only with the patient but also with his relatives. The psychiatrist first tries to find out if the patient has a family history of people with mental disorders and then teaches them how to interact with the person with schizophrenia.

The patient also undergoes all kinds of procedures:

Doctors must make sure that there are no functional abnormalities in the brain. Tests confirm or refute this or that diagnosis. But most of the time, the patient spends with a psychiatrist or psychotherapist. Medications may be prescribed at the beginning of the examination but are not secure. Subsequently, complex therapy is developed.

Treatment

Treatment can take place either on an outpatient basis or on an inpatient basis. The doctor decides this after diagnosis. Therapy consists of the following components:

  • You are taking medications such as neuroleptics, tranquilizers, etc. The course is chosen individually.
  • Psychotherapy sessions aim to correct the person’s behavior and increase his self-esteem. He must become aware of the disease. This will help to restore his ability to work and establish a relationship with others.
  • Instruction – the patient and his relatives are instructed about the remission period. Specialists explain how to prevent future attacks. Also, the patient’s relatives learn about the symptoms for which they need to take the patient to the clinic urgently.

Communication with doctors after treatment is not interrupted. Schizophrenia cannot be cured completely, although sometimes it is possible to achieve a lasting effect when symptoms are controlled for a long time (or even for the rest of your life).

Prevention

To prevent the progression of the disease, the patient must take preventive measures. First of all, you should eliminate bad habits and order your life. In general, doctors advise adhering to the following rules:

  • Follow the daily routine – get up early, get enough sleep, eat on time, and walk outdoors daily.
  • Exercise – exercise, ride a bike, go skiing, or go to the pool.
  • Eliminate stress – avoid conflicts and stressful situations, and limit communication with people who provoke arguments.
  • Eat a healthy diet – avoid alcohol, coffee, strong tea, spicy and fatty foods, and include foods with vitamins and minerals in your diet.
  • See a therapist or psychologist regularly, especially during periods of low energy and poor mood.

Schizophrenia is not a sentence. With this diagnosis, leading a comfortable life at a quality level is possible. But to do so, you will have to work on yourself, your behavior, and your daily routine. The likelihood of relapses is reduced if everything is done according to the doctor’s instructions. However, no specialist will give a 100 percent prognosis since schizophrenia, including slow onset, is a very unpredictable pathology.