Case history F20.00 Paranoid schizophrenia, continuous course. Depressive-paranoid syndrome. Lues. ITU. The course of the paranoid form of schizophrenia and its treatment Diagnosis f20 0 in psychiatry

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The course of the paranoid form of schizophrenia and its treatment

Paranoid schizophrenia, according to ICD-10, is a mental pathology that belongs to one of the types of schizophrenia. Its peculiarity is the predominance of delusions and (or) hallucinations. The remaining symptoms are affective flattening, speech insufficiency is present in a mild form. The disease is the most common of all types of schizophrenia. The syndrome develops after 20 years and can last until the end of life. Prognosis: unfavorable.

The diagnosis can only be made by a psychiatrist after conducting clinical examination procedures and confirming the presence of a number of criteria corresponding to the disorder. When anxious depression is added, a depressive-paranoid form develops.

Differential diagnosis of the disorder

The diagnosis of paranoid schizophrenia involves distinguishing it from clinically similar mental illnesses. Differential diagnosis allows us to exclude alcoholic delirium and jealousy. Of decisive importance in this case is the identification of negative personality changes typical of schizophrenia. The final diagnosis is made after 12 months of observation of the patient.

The cardinal signs of paranoid syndrome are difficulties in communication, peculiar thinking disorders, increasing emotional impoverishment, and mental disintegration.

When diagnosing, the doctor is guided by the rule: for schizophrenia, “everything atypical is typical.” He must take into account such signs as paradox, unusualness, pretentiousness.

Symptoms of the disorder

The depressive paranoid form of schizophrenia develops in stages. The first signs of the disease, according to ICD-10, are the appearance of various obsessions, psychopathic-like disorders and a distorted perception of one’s “I”. At the initial stage of the disease, which lasts several years, symptoms appear sporadically. Over time, the picture is complemented by the appearance of delusional ideas. Depending on the characteristics of the individual at this stage, the range of interests may be narrowed and emotional reactions become impoverished.

The next stage in the development of the disease is the formation of a variant of paranoid schizophrenia. In psychiatry, there are 2 main options, each of which has symptoms unique to it:

• delusional;
• hallucinatory.

In the case of the development of a delusional variant, the carrier of the disorder has a pronounced systematized continuous delusion. The main ideas of delusion can be jealousy, attitude, invention, persecution, influence, rationalization. With this type of disorder, the development of polythematic delusions, characterized by the presence of several interrelated plots, is possible.

Symptoms of this form of the disease include false beliefs. In psychiatry, the concept of “delusion” is interpreted as a set of ideas about the world, born in the patient’s mind as a result of internal processes, without taking into account information coming from the outside world. Such patients not only express ideas, they actively strive to bring them to life. A striking example of this state is the search for possible lovers of one’s partner and accusations of a defamatory relationship against innocent people.

When diagnosing paranoid schizophrenia, it is important to distinguish delusions from, for example, persistent beliefs. In this case, you should know that delirium does not depend on the information communicated to the patient. He may include it in his conclusions, but the very concept that underlies the pathological idea will remain intact.

This form of the disorder is characterized by slight depression of the emotional and volitional spheres. The carrier of the disorder is capable of exhibiting quite adequate emotional reactions, although quite often they have an aggressive overtones. Symptoms of pathology in this case may include disturbances in the motor sphere and changes in mental activity. Patients often “lose their thoughts” and cannot express their thoughts in a structured manner. Senesthopathy appears.

The hallucinatory type of disorder is characterized by less systematicity and duration of delusions. In this case, the history of the disorder includes verbal hallucinations. Carriers of the disorder hear non-existent speech, as if someone is calling them, swearing at them, or commenting on their actions. As a result, patients begin to experience anxiety and fear. Gradually, the hallucinatory-paranoid syndrome takes the form of pseudohallucinations, which are characterized by the sound of other people's voices in the head. Depending on the clinical picture of the pathology, the development of Kandinsky-Clerambault syndrome is possible.

The course of this disorder includes symptoms such as pseudohallucinations, hearing one's own thoughts, and delusions of influence. Delusion of influence is expressed in the fact that patients believe that everyone can hear their thoughts, and someone is directing their flow. The prognosis in the absence of treatment is unfavorable.

Hallucinations are a phenomenon or product generated by the patient’s sense organs. There is a classification of these phenomena, which includes the following types of hallucinations:

The most common are auditory and visual hallucinations. Visual hallucinations have their own classification depending on the images that pop up in the patient’s mind:

• Elementary - spots of light, lines, flashes.
• Object-based - objects emerge in the patient’s mind that can be “taken” from the real world or be a product of a sick mind. The size of these images differs significantly from those that actually exist. Usually in such cases micro- or macroptic hallucinations occur.
• Autoscopic - the carrier of the disorder sees either his double. Or yourself.
• Zoopsia is the vision of birds and animals.
• Extracampal - the patient sees objects that are located outside the field of vision.
• Senesthopathy is the occurrence of sometimes unpleasant pain in different parts of the body without a somatic basis.

The hallucinations listed can be in motion or remain in place, in color or black and white. Auditory hallucinations are much simpler. Hallucinatory-paranoid syndrome most often begins with the appearance of auditory hallucinations. Voices begin to sound in the patient's head long before a diagnosis is made. Voices can belong to several “people” or to one. Often these voices threaten and tell the patient what to do. Sometimes the voices communicate with each other and argue.

Less common are olfactory, gustatory, and tactile hallucinations, which are expressed in sensations of unpleasant taste or smell, which cause refusal to eat and non-existent touches.

Senesthopathy also falls into the rare category. This type of hallucination can manifest itself in the form of hard-tolerable sensations, a feeling of squeezing, burning, bursting in the head, turning over inside something. Senesthopathy can become the basis for delirium.

Variants of the course of paranoid schizophrenia

The International Classification of Diseases defines the following types of disorder:

1. F20.00 - continuous.
2. F20.01 – episodic course with increasing defect.
3. F20.02 – episodic course with a stable defect.
4. F20.03 – episodic remitting course.
5. F20.04 - incomplete remission.
6. F20.05 – complete.

Causes

The significant history of studying paranoid schizophrenia does not allow specialists to name unambiguous factors contributing to its occurrence. However, possible reasons include:

• burdened heredity;
• alcoholism, drug addiction, substance abuse;
• abnormalities of intrauterine development;
• neurobiological disorders;
• social factors.

Treatment of paranoid schizophrenia

Treatment of the syndrome depends on the medical history and clinical manifestations. Currently, thanks to modern developments in pharmacology, treatment of the disorder has a more favorable prognosis. Achieving stable remission allows the complex use of the latest groups of antipsychotics. The action of these drugs is aimed at eliminating productive symptoms, but they are not able to eliminate the personality changes that have arisen. The active stage of treatment lasts from 7 to 30 days.

The prognosis depends on the timeliness of treatment started. With the development of a schizophrenic defect, irreversible personality changes occur. The use of antipsychotics can stop their further development, but not a single drug can return them to normal. In this case, the prognosis is considered unfavorable.

Treatment can be carried out on an outpatient basis, but in severe cases of the disorder the patient is placed in a hospital.

Sustained remission is possible only if you contact a psychiatrist in a timely manner, before personal changes develop. During this period, treatment is applied, the purpose of which is to prevent the disorder from worsening. In especially severe cases, electric shock is used as an inpatient treatment method. The technique is quite complex, but only with its help is it possible to stop the development of depressive syndrome.

Paranoid syndrome cannot be completely cured. Close people should know about this and accept the situation as it is. The favorable prognosis of therapy largely depends on the attitude of his relatives towards the patient. In this regard, treatment includes psychological support and training in tactics for communicating with the patient and his immediate environment.

F20-F29 Schizophrenia, schizotypal and delusional disorders.

F20 Schizophrenia.

F20.0-F20.3 General criteria for paranoid, hebephrenic, catatonic and undifferentiated schizophrenia:

G1. For the majority of a psychotic episode lasting at least one month (or for some time on most days), at least one of the features listed in checklist (1) or at least two of the features listed in checklist (2) must be present.

1) At least one of the following:

a) “echo” of thoughts, putting or taking away thoughts, or openness of thoughts;

b) delusions of influence or influence, distinctly referring to movement of the body or limbs or to thoughts, actions or sensations; delusional perception;

d) persistent delusional ideas of another kind that are culturally inadequate and completely impossible in content, such as identifying oneself with religious or political figures, claims of superhuman abilities (for example, the ability to control the weather or communicate with aliens).

2) or at least two signs from the following:

a) chronic hallucinations of any kind, if they occur daily for at least one month and are accompanied by delusions (which may be unstable and half-formed) without a clear affective content;

b) neologisms, breaks in thinking, leading to discontinuity or inconsistency in speech;

c) catatonic behavior such as agitation, rigidity or waxiness, negativism, mutism and stupor;

d) “negative” symptoms, such as severe apathy, speech impoverishment and flattened or inappropriate emotional reactions (it should be obvious that these are not caused by depression or antipsychotic therapy.

G2. The most commonly used exclusion criteria are:

1) If the case also meets the criteria for a manic episode (F30-) or a depressive episode (F32-), criteria G1.1 and G1.2 above must be met BEFORE the development of a mood disorder.

2) The disorder cannot be attributed to organic brain disease (as set out in F00-F09) or to alcohol or drug intoxication (F1x.0), dependence (F1x.2) or withdrawal state (F1x.3 and F1x.4).

When identifying the presence of the above abnormal subjective experiences and behavior, special care should be taken to avoid false positive assessments, especially where there are culturally or subculturally determined forms of behavior and demeanor, as well as a subnormal level of mental development.

Given the significant variability in the course of schizophrenic disorders, it may be advisable (especially for research purposes) to specify the type of course using the fifth character. The course should be coded at a minimum follow-up of one year (for remission, see note 5 in the introduction).

F20.x0 continuous (during the entire observation period there are no remissions in psychotic symptoms)

F20.x1 episodic with progressive development of the defect; progressive development of “negative” symptoms in the intervals between psychotic episodes

F20.x2 episodic with a stable defect persistent but not progressive “negative” symptoms between psychotic episodes

F20.x3 episodic remitting with complete or virtually complete remissions between psychotic episodes

F20.x4 incomplete remission

F20.x5 complete remission

F20.x8 other type of flow

F20.x9 course undetermined, observation period too short

F20.0 Paranoid schizophrenia.

A. General criteria for schizophrenia should be identified (F20.0-F20.3)

B. Delusions and hallucinations must be significant (such as delusions of persecution, meaning and relationship, high kinship, special mission, bodily change or jealousy; “voices” of a threatening or imperative nature, olfactory or gustatory hallucinations, sexual or other bodily sensations).

B. Emotional flatness or inadequacy, catatonic symptoms or interrupted speech should not dominate the clinical picture, although they may be present in mild severity.

F20.1 Hebephrenic schizophrenia.

B. Must be marked (1) or (2):

1) clear and prolonged emotional smoothness;

2) clear and prolonged emotional inadequacy.

B. Must check (1) or (2):

1) behavior that is characterized more by aimlessness and absurdity than by purposefulness;

2) a distinct thought disorder manifested by broken speech

D. The clinical picture should not be dominated by hallucinations or delusions, although they may be present in a mild degree.

F20.2 Catatonic schizophrenia.

A. The general criteria for schizophrenia (F20.0-F20.3) should be identified, although at first this may not be possible due to the patient’s inability to communicate.

B. One or more of the following catatonic symptoms have been clearly identified for at least two weeks:

1) stupor (significant decrease in reactivity to external stimuli and decrease in spontaneous movements and activity) or mutism;

2) excitement (motor activity without a visible goal, which is not influenced by external stimuli);

3) freezing (arbitrary adoption and preservation of inadequate or bizarre poses);

4) negativism (resistance without visible motives to all instructions and attempts to move, or even movement in the opposite direction);

5) rigidity (maintaining a rigid posture despite attempts to change it);

6) waxy flexibility (preservation of body members in the position that is given to it by other people);

7) automatic obedience (automatic execution of instructions).

F20.3 Undifferentiated schizophrenia.

A. The general criteria for schizophrenia (F20.0-F20.3) must be met.

1) the symptoms are not sufficient to identify the criteria for any of the subtypes F20.0, F20.1, F20.2, F20.4 or F205;

2) there are so many symptoms that criteria for more than one of the subtypes listed above in B (1) are identified.

F20.4 Post-schizophrenic depression.

A. The general criteria for schizophrenia (F20.0-F20.3) should have been met within the last 12 months, but are currently missing.

B. One of the conditions noted in criterion G1 (2) a), b), c) or d) in sections F20.0-F20.3 must persist.

B. Depressive symptoms must be of sufficient duration, severity, and variety to meet the criteria for at least a mild depressive episode (F32.0).

F20.5 Residual schizophrenia.

A. The general criteria for schizophrenia (F20.0-F20.3) should have been identified at some time in the past, but are not currently present.

B. At least 4 of the following “negative” symptoms must have been present during the previous 12 months:

1) psychomotor retardation or hypoactivity;

2) distinct emotional smoothness;

3) passivity and lack of initiative;

4) impoverishment of speech in volume or content;

5) poverty of nonverbal communication, determined by facial expression, contact in the gaze, voice modulation or posture;

6) low social productivity or poor self-care.

F20.6 Simple schizophrenia.

A. Slow progressive development over at least a year of all three signs:

1) a clear change in premorbid personality, manifested by loss of drives and interests, inactivity and aimless behavior, self-absorption and social withdrawal;

2) the gradual appearance and deepening of “negative” symptoms, such as severe apathy, impoverished speech, hypoactivity, emotional flatness, passivity and lack of initiative and poverty of non-verbal communication (determined by facial expression, contact in the gaze, voice modulation or posture);

3) a clear decrease in social, educational or professional productivity.

B. Absence at any time of abnormal subjective experiences indicated in G1 in F20.0-F20.3, as well as hallucinations or sufficiently fully formed delusions of any kind, i.e. the clinical case should never answer criteria for any other type of schizophrenia or any other psychotic disorder.

B. No evidence for dementia or other organic mental disorder as presented in section F00-F09.

F20.8 Another form of schizophrenia.

F20.9 Schizophrenia, unspecified.

F21 Schizotypal disorder.

A. At least 4 of the following must be present continuously or periodically for at least two years:

2) oddities, eccentricities or peculiarities in behavior or appearance;

3) impoverishment of contacts and a tendency towards social withdrawal;

4) strange views (beliefs) or magical thinking that influence behavior and are not consistent with subcultural norms;

5) suspiciousness or paranoid ideas;

6) obsessive chewing gum without internal resistance, often with dysmorphophobic, sexual or aggressive content;

7) unusual perceptual phenomena, including somato-sensory (bodily) or other illusions, depersonalization or derealization;

8) amorphous, detailed, metaphorical, hyper-detailed and often stereotypical thinking, manifested in strange speech or in other ways without pronounced discontinuity;

9) rare transient quasi-psychotic episodes with intense illusions, auditory or other hallucinations and delusional ideas, usually occurring without external provocation.

B. The case must never meet the criteria for any disorder in schizophrenia in F20- (schizophrenia).

F22 Chronic delusional disorders.

F22.0 Delusional disorder.

A. The presence of a delusion or a system of interrelated delusional ideas other than those that were listed as typical schizophrenic under criteria G(1) b) or d) for F20.0-F20.3 (i.e., excluding those that are completely impossible in content or culturally inadequate). The most common examples are delusions of persecution, grandeur, hypochondriacal, jealousy or erotic.

B. Delirium in criterion A must last for at least 3 months.

B. The general criteria for schizophrenia (F20.0-F20.3) are not met.

D. There should not be chronic hallucinations of any kind (but there may be transient or rare auditory hallucinations in which the patient is not discussed in the third person and which are not commentary in nature).

E. Depressive symptoms (or even a depressive episode (F32-)) may be present from time to time, but delusions persist even when mood disorders are not noted.

E. Most commonly used exclusion criteria. There should be no evidence of a primary or secondary brain disorder as specified in F00-F09 or a substance use disorder (F1x.5).

Hint for identifying possible subtypes:

If desired, the following types can be distinguished: persecutory type; litigious type; type with ideas of relationship; the type with ideas of greatness; hypochondriacal (somatic) type; the type with ideas of jealousy; erotomanic type.

F22.8 Other chronic delusional disorders.

This is a residual category for chronic delusional disorders that do not meet the criteria for delusional disorder (F22.0). Disorders in which delusions are accompanied by chronic hallucinatory “voices” or schizophrenic symptoms that do not fully meet the criteria for schizophrenia (F20.-) should be coded here.

Delusional disorders lasting less than 3 months should nevertheless be coded at least temporarily in F23.-.

F22.9 Chronic delusional disorder, unspecified.

F23 Acute and transient psychotic disorders.

G1. Acute development of delusions, hallucinations, incoherent or broken speech, occurring alone or in any combination. The time interval between the onset of any psychotic symptom and the development of the full clinical picture of the disorder does not exceed 2 weeks.

G2. If transient states of confusion, false recognition or disturbances of attention occur, then they do not meet the criteria for organically caused clouding of consciousness as set out in F05.-, criterion A.

G3. The disorder does not meet the symptom criteria for a manic episode (F30.-), a depressive episode (F32.-) or a recurrent depressive disorder (F33.-).

G4. There is insufficient information on recent use of a psychoactive substance that would meet the criteria for intoxication (F1x.0), use with harmful consequences (F1x.1), dependence (F1x.2) or withdrawal states (F1x.3, F1x.4).

Chronic and largely unchanged use of alcohol or drugs in the amount and frequency to which the patient is accustomed does not in itself preclude the use of rubric F23 This should be decided on the basis of clinical judgment and depending on the requirements of the specific research project

G5. Most commonly used criticisms of exclusion: Absence of organic brain disease (F00-F09) or serious metabolic disorder affecting the central nervous system (this does not include childbirth)

The fifth character should be used to indicate the association of the acute onset of the disorder with acute stress (which occurs within 2 weeks before the development of acute psychotic symptoms):

F23.x0 without combination with acute stress

F23.x1 In combination with acute stress

F23.0 Acute polymorphic psychotic disorder without symptoms of schizophrenia.

A The general criteria for acute and transient psychotic disorders should be identified (F23)

B Symptoms change rapidly in both type and intensity from day to day or even within one day

B Presence of any type of hallucinations or delusions for at least several hours at any time since the onset of the disorder

D. Symptoms from at least two of the following categories occurring at the same time:

1) emotional turmoil, characterized by intense feelings of happiness or ecstasy, or overwhelming anxiety or marked irritability;

2) confusion or false recognition of people or places;

3) increased or decreased activity, reaching a significant degree.

E. Any of the symptoms listed in the category of schizophrenia (F20.0-F20.3), criteria G1 and G2, if present, are present for a short time from the onset of the condition, i.e. criterion B in F23.1 is not met .

E. The total duration of the disorder does not exceed 3 months.

F23.1 Acute polymorphic psychotic disorder with symptoms of schizophrenia.

A. Criteria A, B, C and D for acute polymorphic psychotic disorder must be met

B. Some criteria for schizophrenia (F20.0-F20.3) are identified for most of the time from the onset of the disorder, but they do not necessarily meet this diagnosis completely, i.e., they are noted at least:

1) any of the symptoms in F20, F1.1 a-d or

2) any of the symptoms F20, G1.2 from e) to h)

B. Symptoms of schizophrenia of the previous criterion B are detected for no more than one month.

F23.2 Acute schizophrenia-like psychotic disorder.

A. General criteria for acute and transient psychotic disorders are identified (F23).

B. The criteria for schizophrenia (F20.0-F20.3) are identified, with the exception of the duration criterion.

B. The disorder does not meet criteria B, C, or D for acute polymorphic psychotic disorder (F23.0).

D. The total duration of the disorder does not exceed one month.

F23.3 Other acute predominantly delusional psychotic disorders.

A. General criteria for acute and polymorphic psychotic disorders are identified (F23).

B. Relatively stable delusions and/or hallucinations are noted, but they do not meet symptomatic criteria for schizophrenia (F20.0-F20.3).

B. The disorder does not meet the criteria for acute multimorphic psychotic disorder (F23.0)

D. The total duration of the disorder does not exceed 3 months.

F23.8 Other acute and transient psychotic disorders.

Any other acute psychotic disorders that cannot be classified elsewhere in F23 should be coded here (eg, acute psychotic conditions in which distinct delusions or hallucinations occur, but only for a short time). States of undifferentiated excitation should also be encoded here if it is not possible to obtain information about the patient’s mental state, but only in the absence of evidence for organic conditioning.

F23.9 Acute and transient psychotic disorder, unspecified.

F24 Induced delusional disorder.

A. Developmental delusions or delusional systems initially occur in another person with a disorder classified in F20-F23.

B. The two people exhibit an unusually close bond with each other and are relatively isolated from other people.

The patient did not have delusional ideas before meeting another person and in the past he did not develop disorders classified as F20-F23

F25 Schizoaffective disorders.

Note This diagnosis is based on the relative "balance" of the amount of severity and duration of schizophrenic and affective symptoms

G1. The disorder meets the criteria for one of the mood disorders (F30.-, F31-, F32.-) of moderate or severe severity, as defined for each subtype.

G2. For most of the time, for at least a two-week period, symptoms of at least one of the following symptom groups (which almost coincide with the symptom groups of schizophrenia (F20.0-F20.3)) are clearly present:

1) “echo” of thoughts, insertion or subtraction of thoughts, openness of thoughts (F20.0-F20.3, criterion G1.1 a));

2) delusions of influence or influence, clearly relating to movements of the body or limbs or to certain thoughts, actions or sensations (F20.0-F20.3, criterion G1.1 b));

4) persistent delusional ideas of any kind that are culturally inadequate and completely impossible in content, but these are not just ideas of grandeur or persecution (F20.0-F20.3, criterion G1.1 d)), for example, that the patient visits other worlds, can control clouds with his breath, communicate with plants or animals without words, etc.;

5) clearly inadequate or broken speech or frequent use of neologisms (expressed form of criterion G1.2 b) in the category F20.0-F20.3);

6) frequent occurrence of catatonic behaviors such as freezing, waxy flexibility and negativism (F20.0-F20.3, criterion G1.2 b)).

G3. Criteria G1 and G2 must occur during the same episode and at least for some time simultaneously. In the clinical picture, symptoms of both G1 and G2 criteria should be pronounced.

G4. Most commonly used exclusion criteria. The disorder cannot be attributed to an organic mental disorder (within the meaning of F00-F09) or to intoxication, dependence or a withdrawal state associated with the use of psychoactive substances (F10-F19).

F25.0 Schizoaffective disorder, manic type.

B. The criteria for manic disorder (F30.1 or F31.1) must be met.

F25.1 Schizoaffective disorder, depressive type.

A. The general criteria for schizoaffective disorder (F25) must be met.

B. The criteria for a depressive disorder of at least moderate severity (F31.3, F31.4, F32.1 or F32.2) must be met.

F25.2 Schizoaffective disorder, mixed type.

A. The general criteria for schizoaffective disorder (F25) must be met.

B. The criteria for mixed bipolar disorder (F31.6) must be met.

F25.8 Other schizoaffective disorders.

F25.9 Schizoaffective disorder, unspecified.

If desired, the following subtypes of schizoaffective disorder can be distinguished depending on its dynamics:

F25.х0 Only simultaneous development of schizophrenic and affective symptoms. Symptoms are defined in criterion G2 from rubric F25.

F25.x1 Simultaneous development of schizophrenic and affective symptoms with subsequent persistence of schizophrenic symptoms outside of periods of presence of affective symptoms

F28 Other non-organic psychotic disorders.

Psychotic disorders that do not meet the criteria for schizophrenia (F20.0-F20.3) or psychotic types (affective) mood disorders (F30-F39), and psychotic disorders that do not meet symptomatic criteria for chronic delusional disorder (F22.-) should be coded here. ) (an example is chronic hallucinatory disorder). This also includes combinations of symptoms that are not covered by the previous (F20.- categories (F20.-F25), for example, a combination of delusional ideas other than those listed as typical schizophrenic in F20.0-F20.3, criterion G1.1 b) or d) (i.e., in addition to completely incredible in content or culturally inadequate), with catatonia.

What is paranoid schizophrenia

Paranoid schizophrenia is one of the forms of manifestation of a chronic mental disorder. The disease typically begins in early adulthood, between twenty and thirty, and is the best known and most common type of schizophrenia.

Paranoid schizophrenia: characteristic features of the disease

According to the International Classification of Diseases, 10th revision ICD-10, paranoid schizophrenia is coded F20.0. This form of schizophrenia is characterized by two main distinguishing features - the presence of hallucinatory and delusional disorders. In this case, affective disorders (fear, anxiety), catatonic or oneiric symptoms, speech and will disorders may be observed, but they are little expressed or not expressed at all. If certain signs also occur, then experts divide this disease into subtypes:

• affective paranoid schizophrenia (with depressive, manic or anxious variants of the course of the disease);
• catatonic form of paranoid schizophrenia.

Depending on the course of the disease, there are:

• with continuous flow F20.00;
• episodicc with increasing defect F20.01;
• episodicc with stable defect F20.02;
• with paroxysmal progressive course F20.03.

Incomplete remission is coded F20.04, complete remission is coded F20.05.

Thus, the paranoid form can have a varied clinical picture, which in turn indicates the multicomponent etiology (origin) of the disease and the difficulties in making a correct diagnosis.

Periods of development of the disease

Paranoid schizophrenia can be characterized by both acute and slow onset. With an acute onset, a sharp change in behavior is observed: inconsistent thinking, aggressive agitation, unsystematized delusional disorders. There may be increased anxiety, pointless and causeless fear, and strange behavior.

A slow onset is characterized by a duration of unchanged external forms of behavior. Only occasionally there are cases of strange actions, gestures or grimaces, inadequate suspicion, and statements bordering on delusional. There is a loss of initiative, loss of interest in previous hobbies, the patient may complain of a feeling of emptiness in the head.

Sometimes the disease can begin with slowly but steadily increasing pseudoneurotic signs: decreased ability to work, lethargy, the presence of obsessive, overvalued desires or thoughts.

The initial initial stage can also be characterized by depersonalization of the individual (distorted idea of ​​one’s own “I”), confusion, unreasonable fear or anxiety, delusional moods, statements and delusional primary, that is, intellectual perception of the environment.

The development of the initial stage is described by obsessive phenomena (for example, hypochondria) or thoughts, situational or already systematized delusional statements. Often already at this stage of the disease one can notice personality changes: isolation, paucity of emotional reactions. After this, against the background of frequently occurring delusional ideas, hallucinations may appear. As a rule, at this stage - verbal (in the form of a hallucinatory dialogue or monologue). This is how secondary delusional disorder develops.

Then the so-called Kandinsky–Clerambault syndrome begins to predominate with the development of symptoms of pseudohallucinations (that is, without identifying them with real objects or events) and mental automatisms (the perception of one’s own thoughts and movements not as part of one’s mental self, but as part of something alien , inspired by someone else): associative, motor, senestopathic.

The main symptom at the initialization stage is delusional disorders of a hallucinatory nature.

The manifestation of the disease can occur as an acute paranoid disorder or Kandinsky-Clerambault syndrome.

Causes of the disease

The exact causes of this disease, like other forms of schizophrenia, have not yet been established in modern science. Research shows that schizophrenia develops to a greater extent against the background of various brain dysfunctions. This indeed is what it is. But what exactly causes such dysfunctions - a number of genetic factors, environmental factors, pathological changes caused by somatic diseases - is still unknown.

Possible causes of the paranoid form of schizophrenia:

• an imbalance in the production of the neurotransmitter dopamine or serotonin;
• genetic predisposition;
• viral infections during the perinatal (intrauterine period), oxygen starvation;
• acute stress experienced in childhood or early adulthood;
• childhood psychological trauma;
• scientists claim that children born as a result of late pregnancy are at greater risk than children born to young parents;
• drug and alcohol abuse.

Symptoms of the disease

The paranoid type of schizophrenia is characterized by leading and secondary symptoms. According to ICD-10, the diagnosis is made if the general criteria for schizophrenia and the following symptoms are present:

• Affective disorders, which manifest themselves in the form of unreasonable fear or anxiety; alienation, emotional detachment, passivity, and inadequacy of emotional reactions may be observed.
• Catatonic disorders: agitation or stupor.
• General changes in behavior: loss of interest in one’s own hobbies, awareness of the purposelessness of existence, manifestation of social autism.
• There may be signs of incoherent, broken speech and a violation of the sequence of thinking.
• Increased aggression, anger.

All secondary signs and negative symptoms in the clinical picture of the paranoid form of schizophrenia are not predominant or pronounced.

• Delusional ideas that are accompanied by auditory hallucinations. A person may hear voices in his head that tell him about possible “dangers” that await him.
• Visual hallucinations are observed, but much less often than auditory and verbal ones.
• Pseudohallucinations are characterized by the perception of hallucinations in mental subjective space, that is, the objects of hallucinations are not projected onto real objects and are not identified with them.
• The presence of different types of psychological automatisms.
• Stability and systematicity of paranoid delusions.

Depending on the predominance of the main symptom, two subtypes of paranoid schizophrenia are distinguished: delusional and hallucinatory.

In the delusional form of the disease, the leading symptom is characterized by long-term progressive systematized delusions.

The main idea of ​​nonsense (its plot) can be anything. For example, hypochondria, jealousy, reformism, persecution, etc. Polythematic delusional disorder (with the presence of several different plots) may also be observed.

Patients with pronounced delusional paranoid disorder not only express false (“true” on their part) thoughts, but also try with all their might to prove their ideas or translate them into reality.

In the hallucinatory variant of the disease, delusional disorders do not have systematization and duration of manifestations. Such disorders are called paranoid delusions (sensual). Here pronounced verbal and auditory hallucinations are observed. Patients may feel as if someone is calling them and commenting on their actions. Gradually, such voices transform and move from reality to inside. And voices are already sounding in your own head. This is how pseudohallucinations appear and Kandinsky syndrome develops.

Visual and other types of hallucinations are much less common in the paranoid form.

Diagnosis and treatment

The diagnosis of “paranoid schizophrenia” is made on the basis of a complete clinical examination, confirmation of the presence of leading symptoms and a differential diagnosis. It is important to exclude other types of the disease, as well as the induced type of delusional disorder (which is often found in people who were raised in a family with mental illness), organic delusional disorder (which is not endogenous), etc.

Patients with this diagnosis require systematic treatment even when symptoms decrease or disappear completely. Treatment for this illness is similar in many ways to treatment for other types of schizophrenia. And options are selected based on the severity and type of symptoms, the patient’s health status and other factors.

Modern drug therapy includes several stages:

• Active – its task is to eliminate productive symptoms. In this case, different types of antipsychotics are prescribed. Therapy lasts from a week to a month. Such drugs can quickly relieve acute symptoms, but are not at all effective in changing the patient’s personality (forming a schizophrenia defect). New developments in this area in the form of atypical antipsychotics can slow down the development of personality changes.
• Stabilizing - at this stage, some types of medications may be completely canceled or their dosages reduced. The stage lasts from several months to six months.
• Supportive – its task is to record the results obtained and prevent the development of relapses or exacerbation of the disease. Stopping treatment may result in a return of acute symptoms.

In order not to take the medicine daily, pharmacologists developed a deposited form of antipsychotics. An injection of the drug is given every few weeks. The active substance is released gradually, which allows you to maintain the desired level of the drug in the blood.

The patient is also provided with psychological rehabilitation, where professional and social skills are developed.

Paranoid schizophrenia is a chronic disease from which it is impossible to completely recover. Modern medicine is aimed at eliminating acute symptoms and improving the quality of life of patients.

F20 schizophrenia

ICD-10 diagnosis tree

• f00-f99 class v mental disorders and behavioral disorders
• f20-f29 schizophrenia, schizotypal and delusional disorders
• F20 schizophrenia(Selected ICD-10 diagnosis)
• f20.0 paranoid schizophrenia
• f20.1 hebephrenic schizophrenia
• f20.2 catatonic schizophrenia
• f20.4 post-schizophrenic depression
• f20.9 schizophrenia, unspecified
• f20.5 residual schizophrenia
• f22 chronic delusional disorders
• f23 acute and transient psychotic disorders
• f25 schizoaffective disorder
• f28 other non-organic psychotic disorders
• f29 inorganic psychosis, unspecified

Diseases and syndromes related to ICD diagnosis

Titles

Description

Endogenous-processual disorders (DSM heading “Schizophrenia”, “Schizoaffective disorder”, “Schizotypal disorder”) - a group of chronic mental endogenous disorders that have a natural syndrokinesis and syndrotaxis of productive and negative symptoms, occurring with an increase in negative symptoms, the pathognomaniac signs of which are discordant disorders , intellectual-mnestic and emotional-volitional disorders, the development of which leads to the formation of a specific emotional-volitional defect (progression of autism, apathy, abulia) and the operational diagnosis of which is carried out using the criteria of the “Schizophrenia” rubric ISD-10 and DSM-4R.

The history of the study of schizophrenia begins in the second half of the 19th century, when hebephrenia was described by Hecker in 1871, and in 1890 Kahlbaum first mentioned catatonia. The era of luminaries of psychiatry began at the end of the 19th century. Bleier described symptoms pathognomaniac for schizophrenia - discordant thinking disorder, autism, ambivalence, affective dissociation, ambitendence. In 1924, scientists Bumke identified nuclear forms of schizophrenia. Continuously progressive schizophrenia was described by Kleist (1953) and Leonhardr (1960). Subsequently, Kerbikov, Snezhnevsky, Nadzharov, Tiganov, Zharikov and other scientists studied the clinical problem of schizophrenia.

Schizophrenia is a fairly common disease. The incidence ranges from 1.9 to 10 per 1000 population. The incidence varies depending on gender: for men 1.98; for women 1.85. It has been noted that continuous schizophrenia affects men to a greater extent. The highest incidence occurs in adolescence and adolescence, then the incidence rate decreases, but schizophrenia occurs at any age - from the prenatal period to old age.

Causes

1. Dopamine theory proposed by Carsson. It has been determined that in patients with schizophrenia, the synthesis of dopamine is increased and the sensitivity of dopamine receptors is increased. Structures with a high content of dopamine: nigro-striatal, mesencephalic-cortical and mesencephalic-limbic-cortical structures. There is hypersensitivity of dopaminergic receptors in the limbic region and striatum. There is a disruption in the activity of GABA (gamma-aminobutyric acid), an inhibitory substance that affects these receptors.

2. The etiological role of toxic factors was determined in connection with the similarity of the chemical structures of biogenic amines and psychomimetics. It turned out that the structures of norepinephrine and dopamine have much in common with the structure of mescaline. Dimethoxyphenylethylamine was isolated in the urine of patients, which indicates a violation of the methylation of biogenic amines.

3. Impaired function of neuropeptides. Neuropeptides are the basis of intercellular interaction. These include neurohormones, neurotransmitters, neuromodulators, and chemical carriers of specific information.

There are disturbances in 3 groups of neuropeptides:

A) disturbance of neurohumoral function (vasopressin, oxytocin, thyrotropin-releasing hormone);

B) the neurotransmitter function of neuropeptides is to change membrane potentials (substance P);

C) neuromodulatory function: endorphins and enkephalins, similar in structure to opiates, affect specific receptors and have a psychotropic effect.

There are specific indications of genetic aspects in the inheritance of schizophrenia. An important role in this is played by the phenomenon of assortative marriage funnel, which consists in the following: persons with a similar genotype experience a strong sexual attraction to each other, which ultimately leads to the accumulation of homozygous descendants in 3-4 generations. Schizophrenia is characterized by a polylocus (polygenetic) model of inheritance with a predominance of recessive genes. Characterized by incomplete penetrance, translocations of 3 and 8 pairs of chromosomes, the concentration of pathological genes in the 5th pair of chromosomes.

The contribution of genetic factors in the development of schizophrenia reaches 87%, and the type of course and syndrome are mainly inherited.

The risk of developing schizophrenia in a relative of the proband (a person with schizophrenia):

Parents - 14%, brothers and sisters - 15-16%, children 10-12%, aunts and uncles - 5-6%. However, in addition to the risk of developing schizophrenia, relatives have an increased risk of other mental abnormalities.

Risk factors for schizophrenia:

1. Factor X (possibly a perinatal pathology), which causes brain damage with expansion of the lateral ventricles in puberty. It is believed that if factor X did not act during this period, then schizophrenia does not develop after puberty.

2. Perinatal pathology.

3. Schizoid personality type.

4. Schizophrenogenic family (a conformist father is suppressed by a stern and oppressive mother).

5. Cannabinoid intoxication.

6. Conceiving a child in the winter months.

There are also etiological factors that model the causes of schizophrenia:

1. Gender It has been noted that men are more likely to suffer from a continuously progressive form of schizophrenia.

2. Age. There is a concept of age crisis in the development of schizophrenia:

1st age crisis: from early childhood to 3 years (development of early childhood autism);

2nd age crisis: preschool and early school age (presence of childhood fear and delusional fantasies);

3rd age crisis: adolescence (beginning of low-progressive and hebephrenic schizophrenia);

4th age crisis: adolescence (beginning of juvenile malignant schizophrenia);

5 age crisis: 25 – 30 years (paranoid schizophrenia);

6th age crisis: age-related involution – years (schizoaffective disorders);

7th age crisis: pathological menopause (involutional paranoid, involutional melancholy);

8th age crisis: late age - after 65 years (Ekbom syndrome, verbal hallucinosis of fantastic content).

3. It has been noted that schizophrenia has a more severe course in people with low education, qualifications, and financial levels.

Pathogenesis

The pathogenesis of schizophrenia is presented in the form of the following interconnected stages:

1. Brain development disorder. The marker is internal hydrocephalus (dilatation of the lateral ventricles).

2. Impaired metabolism of serotonin and methionine with the formation of indoles, which leads to autointoxication.

3. Disturbance in the dopaminergic system (increased sensitivity to dopaminergic receptors). These disorders cause positive symptoms in schizophrenia.

4. Serotonergic disorders manifest themselves in serotonin deficiency, impaired sensitivity of serotonergic receptors. They cause discordant disorders and negative symptoms.

5. Autoimmune pathology. During exacerbations of schizophrenia, an increase in the concentration of autoantibodies and disruption of the protective function of the blood-brain barrier are observed.

6. Pathological activation of the left hemisphere of the brain contributes to the development of hallucinatory-paranoid symptoms and discordant disorders. Pathological activation of the diencephalic parts of the right hemisphere contributes to the emergence of schizoaffective symptoms and, on the other hand, neurosis-like and psychopathic-like disorders (in low-progressive schizophrenia).

Symptoms

Increased sensitivity in the premorbid period, before the development of obvious clinical signs of the disease, consists of a very subtle perception of how other people treat a person, but he, in turn, cannot feel the state of his interlocutor.

Types of pathological personalities found in the premorbid period of schizophrenia:

1. No features.

2. Sensitive schizoids - vulnerable, reactively labile, with neurotic reactions, “mimosa-like”.

3. Emotionally cold and expansive schizoids - emotionally depressed, with monotonous, rigid, overvalued activity, expansiveness.

4. Exemplary - sluggish, passive, obedient, reasonable, with sluggish instincts.

5. With the presence of a disproportion between high intelligence and motor clumsiness.

6. Unstable, excitable, with disinhibited drives and motor skills.

8. Hysterical personalities.

9. Psychasthenic personalities - anxious and suspicious, with reflection, a tendency to self-examination, and uncertainty.

10. Asthenic individuals with sensitivity, weakness, increased fatigue.

11. Pedintic-rigid (anankaste) personalities.

12. Paranoid and psychopathic individuals are expansive, sensitive, sluggish fanatics, “fighters for justice.”

13. Infantile personalities with a long-lasting childish style.

14. People characterized by strange behavior.

Productive disorders in schizophrenia.

1. Neurosis-like disorders:

A) with a predominance of asthenic disorders (lethargy, fatigue, irritability), the creation of a special gentle regime, hypothymia;

B) inadequate fears are stereotypical and absurd (in children);

C) with a predominance of obsessiveness, a feeling of timidity, hypothymia, phobias, and later - a system of rituals and mentism with the fear of going crazy;

D) with a predominance of depersonalization and derealization;

D) non-delusional dysmorphophobic and dysmorphomanic ideas;

E) hypochondriacal-senestopathic conditions;

G) episodic ideas of relationship, calls, individual and unstable mental automatisms.

2. Psychopathic-like disorders:

A) increased affective lability;

B) a state with hypersthenicity, monotonous activity, a tendency to paranoid reactions and unstable overvalued education;

C) psychopath-like states with increased sensitivity, a tendency to unstable individual ideas of attitude;

D) conditions with a predominance of hysterical disorders, which are characterized by tearfulness, capriciousness, a tendency to quarrel, vaso-vegetative lability;

D) psychopathological conditions with increased excitability and heboid disorders;

E) states that include episodic ideas of relationship, calls, and individual mental automatisms.

3. Extremely valuable education:

A) unusual autistic interests and games, autistic fantasies of an overvalued nature (in children). Ridiculous collecting, stereotypical solo games with no practical value;

B) phenomena of metaphysical intoxication - rudimentary paranoia with a passion for abstract philosophical teachings and modernist trends. This hobby is not productive;

C) overvalued dysformophobia and mental anorexia. Confidence in the presence of a defect in appearance or fatness, sensitive ideas of attitude, subdepression, the desire to correct the identified defect.

4. Mild affective disorders:

A) subdepression of a cyclothyme-like level with daily mood fluctuations;

B) adynamic (apathetic) subdepression;

C) hypomania of a cyclothyme-like nature with increased mood, motor and intellectual activity, rudeness, harshness, disinhibition;

D) hypomania with psychopathic behavior;

D) repeated subdepressions with short remissions;

E) frequent changes of hypomanic and sublepressive states with short remissions;

G) continuous change of hypomanic and subdepressive states.

5. Affective syndromes:

A) depression with obsessions;

B) depression of the endogenous type, including anesthetic with ideas of self-accusation and condemnation;

B) depression with anxiety and agitation;

D) manic states of circular type – level of psychotic mania;

D) mixed non-delusional affective states.

6. Affective-delusional syndromes:

A) endogenous depression with persecutory delusions and/or hypochondriacal delusions;

B) depression with hallucinations and pseudohallucinations;

B) manic-delusional states;

D) mania with hallucinations and pseudohallucinations;

D) depressive-paranoid states with intermetamorphosis;

E) acute paraphrenic states.

7. Affective-catatonic states:

A) depressive-catatonic state;

B) manic-catatonic state;

B) manic-hebephrenic symptoms.

8. Oneiric conditions:

A) reduced oneiric states with lability of affect, fear, mania with confusion, figurative and sensory delirium without a specific plot;

B) oneiric-affective states (oriented oneiroid, a combination of true and fantastic orientation);

B) oneiric-catatonic states (true oneiroid);

D) fibril-catatonic states.

9. Acute delusional syndromes:

A) acute sensory delirium;

B) acute paranoid state;

B) acute Kandinsky-Clerambault syndrome;

10. Paranoid states:

A) delusion of pretension, overvalued delusion, dysmorphomania of a paranoid nature. There is a monothematic, affectively colored delirium. Patients are obsessed with the idea of ​​psychological clarity of delirium. Possible delusions of reformism, litigious delusions, hypochondriacal, dysmorphomaniacal, jealousy, sensitive delusions of relationship, erotomanic;

B) paranoid delusion with affective fluctuations;

B) persistent paranoid delusions.

11. Chronic paranoid states.

12. Paraphrenic states.

13. Other delusional states.

14. Catatonic-paranoid states.

15. Catatonic states:

A) catatonic and catatonic-hebephrenic stimulation;

B) catatonic stupor.

16. Final states:

A) accompanied by underdeveloped or unstable catatonic symptoms of the catatonic circle. Microcatatonic symptoms are characteristic;

B) state of catatonic akinetic circle;

B) states such as hyperkinetic-catatonic circle;

D) with a predominance of fantastic delirium;

D) states of hallucinatory-delusional type;

E) states of catatonic-delusional and catatonic-hallucinatory type.

Treatment

Schizophrenia is a disease with a fundamentally favorable course, i.e. With proper treatment, the vast majority of patients experience long-term and high-quality remission. Therapy for schizophrenia is a complex of medications, psychotherapeutic, intensive and other methods of influencing the etiopathogenesis of the disease.

The main group of drugs used for schizophrenia are called antipsychotics. According to the classification, 9 classes of antipsychotics are identified:

1. Phenothiazides (aminazine, neuleptil, mozeptil, teralen).

2. Xanthenes and thiaxanthenes (chloroprotexene, clopixol, fluanxol).

3. Buterophenones (haloperidol, trisedyl, droperidol).

4. Piperidine derivatives (imap, orap, semap).

5. Bicyclic derivatives (rispolept).

6. Atypical tricyclic derivatives (leponex).

7. Benzadiazepine derivatives (olanzapine).

8. Indole and naphthol derivatives (moban).

9. Benzamide derivatives (sulpiride, metoclopramide, amisulpride, tiapride).

Neuroleptics (antipsychotics) affect the dopamine system and are dopamine receptor antagonists. Their action leads to an antipsychotic effect. Disturbances in the serotonergic system that cause negative symptoms are also treated with antipsychotics. The action of neuroleptics causes side effects, primarily extrapyramidal disorders. The newest neuroleptics, or atypical antipsychotics (risperidone, olanzapine) have equal similarity to dopamine and serotonin receptors, are comparable in effectiveness to classical antipsychotics, and are much better tolerated. Each of the antipsychotics has individual characteristics of pharmacodynamic activity. Neuroleptics in small doses eliminate affective, anxiety-phobic, obsessive-compulsive, somatoform disorders and compensation for personality anomalies, primarily of an endogenous-process nature. In large doses, antipsychotics reduce psychomotor activity and have an antipsychotic effect. They also have an antiemetic effect. The neurotropic effect of neuroleptics causes extrapyramidal and autonomic symptoms.

In addition to antipsychotics, antidepressants, thymostabilizers, tranquilizers and other groups of drugs are used to treat schizophrenia.

Psychotherapeutic work and various types of trainings play an important role. Physiotherapy.

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Schizophrenia is a severe and mental illness in which emotional disturbances, inappropriate behavior, impaired thinking and the inability to lead a social life are observed. It usually develops in men aged 18–25 years and in women aged 26–45 years. Sometimes it is inherited. Risk factors are experienced events that caused stress. Gender doesn't matter. The disease occurs across cultures and affects approximately one in a hundred people worldwide.

Etiology

The term "schizophrenia" is sometimes mistakenly used to describe personality disorders. The disease leads to a violation of a person’s sense of reality, which is accompanied by inadequacy of his behavior and confusion of emotional reactions. People with schizophrenia may hear voices, which may contribute to strange behavior. They usually need support and constant attention, and find themselves unable to work or maintain relationships with other people. About one in ten people diagnosed with schizophrenia commit suicide.

Risk factors

So far, no cause has been identified that causes this disease, but it is known that genetic predisposition plays some role. In a person who has been in close contact with a person with schizophrenia for a long time, the risk of developing the disease increases significantly. In addition, experienced events that caused stress, such as a serious illness or bereavement, can serve as a precipitating factor in the development of the disease for a person who has a predisposition to it. There is evidence that schizophrenia has abnormalities in the structure of the brain, such as cysts or fluid-filled cavities formed by the destruction of brain tissue.

Symptoms

Usually the disease manifests itself gradually, starting with the patient's loss of vital energy. In other cases, it occurs more unexpectedly; the cause of its occurrence may be the stress suffered. Sometimes the course of schizophrenia is divided into episodes in which the disease manifests itself clearly, but between which the patient may demonstrate a complete absence of the disease, and sometimes the disease proceeds more or less continuously.

Symptoms of schizophrenia may include:

• voices heard by the patient, which no one but him hears and cannot hear;
• the patient's irrational beliefs, in particular, the belief that his thoughts and actions are controlled by some otherworldly force;
• the patient may believe that he himself is a great personality, such as, for example, Napoleon, or that the most trivial objects or events have a deep, great meaning;
• expression of inappropriate emotions (the patient may laugh when receiving bad news);
• incoherent speech, rapid transition from one topic of conversation to another;
• deterioration in concentration;
• slowness of movements and thought process;
• anxiety, excitement.

A person suffering from schizophrenia may be depressed, lethargic, and self-absorbed. Perhaps the patient will begin to neglect taking care of his own needs, becoming more and more isolated from others.

To help the patient regain organization, medications may be prescribed. It may take about 3 weeks for a person to get rid of the most obvious symptoms of the disease. Some medications can cause serious side effects (such as tremor), in which case their dosage may need to be adjusted or other medications added to reduce these side effects. After examination and treatment, patients are usually discharged home, but it should be remembered that they absolutely need support and a calm, safe atmosphere in the family. People suffering from schizophrenia need to be protected from stressful situations, because... Excitement can lead to symptoms of the disease. They also need frequent and regular contacts with social and psychological service workers monitoring their condition.

Both patients and their family members can benefit from counseling psychotherapy. People close to the patient should promptly notice signs of an incipient relapse and indications that the patient is plunging into a general state of apathy and self-neglect.

For most people with schizophrenia, their illness is chronic. However, approximately one in 5 patients suddenly reaches a point at which they begin to return to normal life. Most experience multiple episodes of acute symptoms, during which they may require hospitalization, interspersed with periods of recovery. The use of modern medications improves the prognosis, but to prevent relapses of the disease, these people need adequate care and support from society. The prognosis is less favorable for patients whose disease gradually developed from a young age.

Schizotypal personality disorder has rather vague symptoms, which almost always include emotional coldness and detachment, eccentric behavior and appearance, so-called magical thinking that does not correspond to generally accepted cultural norms. Patients, as a rule, are not able to adequately interpret current events, since it seems to them that they do not make any sense. Other symptoms of a personality disorder may include various speech disorders. The patient cannot conduct a consistent conversation, often switches to distant topics and loses the thread of the conversation. Speech becomes vague and incoherent, the person speaks in fragments of phrases that he repeats constantly. Schizotypal disorder almost always manifests itself as social alienation of the patient. He is able to communicate normally only with a limited circle of people, as a rule, these are close relatives who are aware of the pathology and who have managed to adapt to its characteristics. Strangers not only do not understand the patient’s behavior and speech, but can also cause him to have attacks of panic, anger and aggression. Quite often, with schizotypal personality disorder, symptoms such as communicating with imaginary people or with oneself are observed. During periods of such communication, a person may exhibit openness and emotional reactions that are not usually characteristic of him: crying, screaming, etc. At these moments, the patient can share with an imaginary interlocutor his experiences, childhood memories, and experienced events. Despite the fact that the patient always tries to isolate himself from society, he does not consider himself lonely. In real life, such people are very withdrawn and uncommunicative, their mood often changes for no apparent reason, obsessive ideas and thoughts appear, excessive suspicion and paranoia. Disorders such as derealization and depersonalization, hallucinations and delusional states may occur, which cannot be interpreted as a real delusional disorder.