Schizophrenia in men: causes, types, diagnosis, prognosis

More than a century has passed since the moment schizophrenia was singled out as an independent disease, but discussions still continue not only about its nature, but also about its very existence as a separate disease. Many psychiatrists, including E. Bleuler, the author of the term "schizophrenia", are inclined to believe that this is a group of mental illnesses united by a common feature - the patient's mental process is disturbed, the unity of perception, thinking and emotions disappears against the background of progressive weakening of mental activity. Be that as it may, the most malignant and rapidly progressive forms of the disease manifest in adolescence and youth, and among young patients, the majority are male patients. Therefore, schizophrenia in men, in general, is more severe and has a less favorable prognosis than in women. Although in some cases the opposite is true.

A fairly rapid, often within ten to fifteen years, impoverishment of the entire mental life of patients, a “fatal outcome in dementia” at a fairly young age was considered the main property of the disease, which at the end of the 19th century was described by E. Kraepelin as an independent nosological unit, combining previously considered separate mental pathologies: dementia praecox, catatonia, herbephrenia and paranoia. She was the prototype of schizophrenia. E. Kraepelin left the name "dementia praecox", since all these mental disorders manifested in adolescence and adolescence and rapidly progressed with the outcome in dementia. It was this disease that mainly affected young males.

However, literally 15 years later, with the light hand of E. Bleuler, who noted that this pathology is not always early and a quick “fatal outcome to dementia” is also not observed in all patients, a new independent mental illness appeared - schizophrenia. Its main feature was called the splitting of the integral psyche. [1]

Mental disorders in men

It is not easy to maintain mental health until old age in the modern world, especially for residents of megacities. According to the World Health Organization, mental disorders in varying degrees, temporarily and permanently suffer from 20-25% of the world's inhabitants, regardless of gender and age. Mental disorders are temporary, that is, caused by severe mental shocks or the abuse of psychotropic substances. Such conditions are not long-term and most often have a favorable outcome. Chronic or permanent mental disorders, which include schizophrenia, occur for a long time, with exacerbations and lead to the emergence of a persistent mental defect.

The most common mental health disorders are depression, bipolar disorder and schizophrenia. And if depression is treatable and can pass without a trace, then the other two are chronic relapsing diseases, which in most cases are controlled by medication.

Depression develops in men half as often as in women. Since the time of E. Kraepelin, bipolar disorder has also been considered a more “female” mental disorder. Although modern studies contradict this and indicate that men are more likely to suffer from bipolar disorder, and women are more prone to monopolar disorder with a predominance of "black bars" in the psycho-emotional state. It is possible that the ambiguity of the diagnostic approach affects such statistics.

Among patients diagnosed with schizophrenia, there are three women for four men, and schizotypal affective disorder is also somewhat more common in men.

There are more addiction diseases in the male population. At the beginning of the last century, there was one woman for every 12 regular drinkers. Alcoholic psychoses are still the prerogative of men, although the representatives of the beautiful half of humanity are actively catching up with them, and according to UK statistics, gender equality has already been established among those suffering from alcoholism in their country. Nevertheless, there are still four men for every female alcoholic among the entire population of the planet (WHO data). In general, there are 1.3-1.5 times more male drug addicts than females. But men are not subject to eating disorders - for ten women suffering from anorexia / bulimia, there is only one man.

Young men are more likely to suffer from autism spectrum disorders, speech disorders, hyperactivity disorder and attention deficit disorder.

Why is schizophrenia dangerous in men?

The disease, first of all, is dangerous for the patient himself, and regardless of gender, in that in the absence of treatment, it progresses. The disturbed integrity of the psyche gives rise to the inability of the patient to control his behavior, change it in accordance with life circumstances, not go beyond social rules, plan his life and implement his plans. All this makes a person dependent on others, their help and care, depriving him of independence.

If we compare men with women, then, in general, their painful symptoms appear earlier, and in adolescence and adolescence (sometimes in childhood) they manifest by no means benign forms of schizophrenia. In men, developed and persistent delusional disorders are more often observed, a state of psychomotor agitation develops. Nevertheless, a more stormy and dramatic debut, a visible abnormality of behavior, although it usually makes a heavy impression on others, allows you to start treatment in a timely manner, resulting in less damage to the patient's psyche. The slow development of the disease is fraught with a later start of treatment and greater mental status disorders.

In addition, males are characterized by combinations of schizophrenia with antisocial behavior, substance abuse, and alcoholism, which aggravates the course of the disease and is more reflected in family and professional status.

The way out of the situation is to seek medical help in a timely manner. Schizophrenia in most cases is controlled by active psychotropic therapy, and its combination with socio-rehabilitation practices allows the patient to return a fairly high quality of life. The greatest danger in schizophrenia is considered to be a late start of treatment.

Among persons with especially dangerous criminal behavior, for example, serial killers, there are not many schizophrenics, among professional criminals - too. Patients with schizophrenia, in general, do not pose a danger to society. This is explained, first of all, by the fact that the development of the disease leads to stupefaction, isolation, fencing off from the outside world. [2]

Epidemiology

Morbidity statistics show that among young patients, the vast majority of male patients, the peak incidence occurs at the age of 20-28 years. However, one third of the onsets of schizophrenia occur between the ages of 10 and 19 and it is assumed that not all onsets are recognized. Boys among the youngest patients are 1.5-2 times more than girls. The likelihood of developing schizophrenia in adolescence and youth is 3-4 times higher than in the middle and elderly. Most often at the age of 10-14, a malignant continuous form of the disease manifests itself, a milder paranoid one - after 20-25 years.  [3].  [4]. [5]

Causes Schizophrenia in men: causes, types, diagnosis, prognosis

Modern psychiatry, based on the achievements of neurophysiology, considers this disease as a result of a violation of neurotransmitter mechanisms due to damage to some cerebral structures, since structural anomalies are already present during the manifestation of schizophrenia. There is evidence of brain damage at the earliest stages of its development. For example, in patients with schizophrenia, an expansion of the cavity of the transparent septum and a violation of the folding of the brain were found. Such structures develop shortly after birth and remain virtually unchanged thereafter. These facts confirm the neurogenesis theory of the pathogenesis of schizophrenia. Modern research methods have suggested that the development of the disease is based on degeneration of brain cells, especially gray matter, and / or neurochemical imbalance, which began at the stages of intrauterine development. The causes of pathological transformations are perinatal infections, intoxications, and other harmful effects during childbearing. However, the findings of neuroscientists lack specificity and are inherent in individuals with other psychiatric diseases.

Genetic predisposition also takes place, it is confirmed by twin studies and the presence of structural disorders in close relatives of patients, expressed to a lesser extent. Inheritance is quite complex, hypothetically several mutated genes interact, which leads to a critical increase in the risk of developing schizophrenia. Several functional and metabolic cerebral processes are presumably disturbed at once, which leads to changes in the psyche that fit into schizophrenia-like symptoms. But heredity is not recognized as a decisive factor either, since far from all children of schizophrenic parents fall ill, mutations specific to schizophrenia have not been found. In addition, in some cases, gene transformations were random and were absent in the patient's parents. [6]

The influence of various external triggers is recognized. Risk factors - living conditions in early childhood (dysfunctional family, poverty, loneliness, frequent change of residence, emotional and physical bullying), stress, intoxication, infection, level of physical activity, psychological and social interactions of various kinds in childhood and adulthood only accelerate the onset of symptoms of schizophrenia in men. Among the social conditions that provoke the development of the disease, living in an urban area is highlighted. A higher degree of urbanization in genetically predisposed people increases the risk of developing the disease. Psychological risk factors are also varied. Schizophrenics are very sensitive even to minor negative stimuli, they are often worried about what an ordinary person may simply not notice, even any far-fetched stress factor can serve as an impetus for the development of the disease.

The use of various kinds of psychedelics as such can cause schizophrenia-like symptoms, and it can manifest itself in acute intoxication as a result of taking a single large dose and chronic intoxication with prolonged abuse. In addition, patients with schizophrenia often use psychotropic substances (most often alcohol as the most popular and affordable product) to overcome their characteristic dopamine hunger. In such cases, it is almost impossible to establish what exactly was primary, and if it is known for certain that a schizophrenic-like condition is observed in a chronic alcoholic or drug addict, then he is diagnosed with severe intoxication or withdrawal syndrome, and not schizophrenia.

Periods of risk are crises associated with changes in hormonal and social status. In men, this is adolescence, when, against the backdrop of rapid physical restructuring and social development, most of the debuts of the disease occur. Late schizophrenia manifests itself in predisposed men during the period of attenuation of sexual function, which also coincides with changes in social status (retirement, loss of former significance).

However, as a result of external influences alone, one does not become schizophrenic. Exogenous risk factors are superimposed on congenital predisposition. In most patients' anamnesis, it is impossible to trace a clear connection between a certain external factor and the onset of the disease. [7]

Risk factors

Schizophrenia is an endogenous disease, the exact causes of which are still hidden by a veil of secrecy. Currently, it is considered as a consequence of degenerative processes occurring in the neurons of the brain, the beginning of which is laid at the stage of its formation.

Substance abuse and various stressors can contribute to the onset of another bout of schizophrenia, however, their effects alone will not be enough to develop the disease.

In predisposed individuals, external factors may provoke the first attack or debut of schizophrenia, although, in general, the manifestation of the disease occurs without apparent connection with external influences. Most often, the symptoms of schizophrenia precede the appearance of a pronounced craving for alcohol or other psychedelics. One of the reasons that almost half of schizophrenics use psychoactive substances, and alcohol is the most accessible of them, experts call the patient's desire to neutralize the fear of growing emotional changes. And, in a way, it allows you to forget for a while, reduce emotional stress, anxiety, drown out longing, but at the same time, psychological dependence is formed.

A characteristic symptom of alcoholism in a patient with schizophrenia is the absence of visible reasons for drunkenness and the tendency to drink strong drinks alone. Drunkenness acquires a drunken character, and the state of intoxication is accompanied by excitement, hysteria, and malicious antics.

Signs of schizophrenia in a man due to alcoholism may be noticeable, because these are delusions and hallucinations, as well as negative symptoms (growing indifference, inactivity, apathy). But these signs also appear with prolonged chronic alcoholism. The state of psychomotor agitation that accompanies withdrawal syndrome or acute alcohol intoxication also resembles the rapid onset of schizophrenia. In this case, it is almost impossible to differentiate what was primary, therefore, patients who have not previously been diagnosed with schizophrenia are diagnosed with alcohol dependence syndrome.

Sometimes the first signs of schizophrenia in a man due to stress can be noticeable. But only a traumatic situation for the development of the disease is also not enough. There must be a predisposition, perhaps the process developed imperceptibly, and stress provoked the rapid development of the disease. I repeat that in most cases, neither the patients nor their relatives associate the first symptoms of the disease with a specific stress factor. It is the unexpected manifestation of schizophrenia in the midst of complete well-being that experts emphasize as one of the signs that make it possible to suspect this disease.

Schizophrenia cannot develop on the basis of jealousy in men. The basis for this misconception is the fact that the delusion of jealousy is one of the typical themes of delusional disorder in schizophrenics. Pathological jealousy is not typical for the initial stage of the disease. The so-called Othello syndrome usually manifests itself in the stronger sex by the age of 40 and, unlike women, it is accompanied by aggressive manifestations.

Morbid jealousy is a common symptom of a number of mental disorders. Its development can be aggravated by alcoholism, drug addiction, acquired physical disabilities, a tendency towards isolation characteristic of schizophrenia.

In general, external psycho-traumatic factors alone are not enough for the development of schizophrenia. In addition, such a diagnosis is usually made not by relatives, but by psychiatrists after a comprehensive examination and observation of the patient, often in a hospital. [8]

Pathogenesis

Many theories try to explain the pathogenesis of schizophrenia from the point of view of neurobiology - dopamine, kynuren, GABAergic and others. In patients with schizophrenia, almost all the processes of transmission of nerve impulses are affected in one way or another, but so far none of the hypotheses can reliably explain what is happening anyway, to accurately indicate the brain systems whose functions are deteriorating. Moreover, the studies involve long-ill patients who are on long-term antipsychotic therapy, which, on the one hand, leads to the normalization of certain brain structures, for example, the basal ganglia, and at the same time, under the influence of drugs in the substance of the brain, there are other structural deformities and areas of cerebral ischemia. At present, it has not been possible to completely separate the contribution of antipsychotic treatment from the structural abnormalities caused directly by the disease.  [9], [10]

Symptoms Schizophrenia in men: causes, types, diagnosis, prognosis

According to the type of course of the disease process, continuous schizophrenia is distinguished, the manifestations of which are always present, but can be periodically expressed to a greater or lesser extent (atrial character). There is also a recurrent or circular, which manifests itself periodically and resembles a manic-depressive psychosis, as well as the most common, mixed or paroxysmal-progressive, when attacks of the disease occur rarely, after 3-5 or more years, but from relapse to relapse, they become more complicated and each time negative symptoms progress. It is also called fur-like - with each relapse, the patient sinks deeper into the disease (schub in German - a step down).

There are also varieties of schizophrenia according to the predominant clinical manifestations.

The most malignant form of continuous schizophrenia, which affects mainly male patients, manifests itself in adolescence (12-15 years). Juvenile schizophrenia is characterized by rapid progress and an increase in emotional and intellectual degradation (corresponds to Kraepelin's dementia praecox). According to its characteristic manifestations, it is divided into three main types:

• simple schizophrenia - characterized by a predominance of negative symptoms and a practical absence of productive manifestations: quite normal teenagers suddenly become unbearable for others - rude and indifferent to relatives, in educational institutions - truants and lazybones, sleep for a long time, become unsociable; quickly degrade - they become sloppy, gluttonous, sexually liberated, in many cases unmotivated aggression towards others is manifested;
• hebephrenic schizophrenia, a distinctive feature of which is a behavioral disorder with gross antics, grimaces, buffoonery absolutely inadequate for age and situation, patients also have sexual disinhibition (public masturbation, exposure of the genitals), gluttony and slovenliness, deliberate emptying of the intestines and bladder in front of everyone in inappropriate places, literally within the first or second year from the onset of the disease with simple and hebephrenic schizophrenia, an end state is formed with loss of mental activity and dementia, in the first case it is complete indifference, in the second - the so-called "mannered" dementia;
• catatonic schizophrenia, a distinctive feature is catatonia, manifested by stupor (psychosis of tension) or arousal, described above, with this form the final state (“dumb dementia”) is formed in about two to three years.

Paranoid schizophrenia in men begins much later after 20 or even 25 years, the development of the disease occurs slowly, through all stages and the patient's personality structure changes gradually. It proceeds both in a continuous and paroxysmal-progredient form.

There is delirium - persecution, influence, relationships, messianism. A person interprets all the events and behavior of others from the point of view of delusional ideas, becomes secretive, suspicious, wary. Paranoid delirium develops and becomes more complicated, hallucinations appear, more often auditory - voices ordering, discussing, sounding thoughts, against this background mental automatisms are formed and the patient's behavior becomes psychotic. This stage of the disease is called paranoid or hallucinatory-paranoid.

Patients may develop secondary catatonia, delusions become more and more grandiose, delusional depersonalization may be observed. Patients often imagine themselves as historical figures, deputies of the gods, which is noticeable in their condescending tone, proud behavior, showing their sense of their own superiority. At this stage, specific symptoms of schizophrenia appear - schizophasia, mentism, pseudohallucinations, openness, withdrawal or introduction into the brain from thoughts, moods, dreams, imposition from movements, feelings, etc. The more fantastic the plot of delusion, the greater the personality defect sick. Eventually paranoid dementia develops. However, it is this form of schizophrenia that in most cases is well controlled by drugs and the third stage of the disease can be delayed for a very long time.

Fur-like (progressive-progressive) type of course of paranoid schizophrenia develops at first as continuous, but quickly resolves, and the patient can live a normal life for several years. Then, after a few years, the disease returns, the attack becomes more complicated and lengthens in time, but again stops. The patient comes out of each attack with some autistic loss. Previously, before the discovery of neuroleptics, a third or fourth attack in such a course led to the final stage of the disease. Currently, drug therapy can delay and even prevent the onset of the return of the disease. In this form, juvenile schizophrenia (catatonic, hebephrenic) can also occur. It is more favorable, and a smaller intellectual defect is formed in patients than with a continuously flowing form.

Recurrent schizophrenia is a periodic development of manic or depressive psychoses, deployed to a greater or lesser extent, with delusional, hallucinatory, mixed components, pseudohallucinations in the clinical picture. Reminds me of schizoaffective psychosis.

Manic attacks are excited states with specific symptoms of schizophrenia (echo of thoughts, delusions of influence) up to the development of oneiroid catatonia.

Depressive attacks are characterized by low mood, sleep disturbances, premonitions of misfortune, anxiety with specific symptoms of schizophrenia (delusions of persecution, poisoning, exposure). A stuporous or oneiroid state may develop. Such attacks are well stopped by drugs, however, after their resolution, personal capabilities are somewhat lost.

Sluggish schizophrenia in men can manifest at any age. In the beginning, it has neurosis-like symptoms. It is now classified as schizotypal personality disorder. The mildest and least progressive form of the disease described above, and often does not lead to intellectual loss.

There is no such variety as latent schizophrenia in men, because as long as the disease is hidden and neither the patient nor the environment is aware of it, it does not exist. It is impossible to diagnose a mental illness that is asymptomatic.

Alcoholic schizophrenia in men is also not a correct definition. As mentioned earlier, schizophrenics are prone to drinking alcohol, but the development of schizophrenia only on the basis of alcoholism is not considered possible by modern medicine, although the degradation of brain neurons in chronic alcoholics and the development of symptoms resembling schizophreniform psychosis takes place.

The most dangerous form of the disease is the hypertoxic or febrile form of schizophrenia. It is characterized by a sharp, during the first five days, increase in the patient's body temperature, without connection with the somatic state or antipsychotic therapy, against the background of developing acute psychosis with catatonic symptoms. The patient is hospitalized in a hospital and is provided with emergency care, since his condition poses a risk to life. The prefebrile phase is characterized by pronounced excitation: the speech of patients is stilted, incoherent, meaningless, movements are impulsive and unnatural. Patients are exalted, do not close their mouths, but are somewhat confused, often there is a syndrome of depersonalization / derealization. Sometimes symptoms of catatonia are immediately observed. After an increase in temperature, catatonic, hebephrenic excitation or catatonic stupor joins. Patients jump, somersault, grimacing, spitting, undressing, attacking others, later comes a negativistic stupor with an increase in muscle tone and / or oneiroid.

At present, a scheme for the treatment of febrile seizures of schizophrenia has been developed, which makes it possible to achieve a pronounced remission. Previously, standard antipsychotic therapy was often fatal. A febrile attack is mainly manifested by fur-like schizophrenia, subsequent exacerbations in a patient usually proceed with a normal temperature.

Stages

Like any disease, schizophrenia develops in stages. However, the stages in different forms of the disease are expressed to varying degrees and their duration does not always make it possible to clearly distinguish each of them. In addition, there is a prodromal period when the patient does not yet feel like one, and others consider him strange, capricious, uncontrollable, and if this happens to a teenager, then everyone is written off as a “transitional age”.

In a pre-morbid state, inexplicable internal discomfort, mental pain are usually felt, the harmony of the external environment and the patient's inner world is disturbed. But these feelings are not specific. They are all there. This affects unnatural behavior, it is difficult to communicate with friends, with relatives and relatives. A person feels special, not like others. He “drops out” of society and gradually loses contact with it. Communication with others more and more strains the patient, and he prefers loneliness. Sometimes after such a period there is a violent onset in the form of psychosis.

But often the initial stage of schizophrenia in men is hidden. This is how the most difficult-to-treat forms of continuous juvenile schizophrenia, or a sluggish process that also often manifests itself in adolescents, begin in adolescence. A characteristic early symptom can be completely different behavior, for example, at home and in the company of strangers (at school, at work, etc.) - “behavior splitting”. Among relatives, this is an eloquent person, ready to talk for hours on various topics, argue to the point of hoarseness, defending his opinion, sometimes aggressively; in the company of strangers, even well-known ones, he tries to “keep his head down”, is silent, you can’t get a word out of him, he is timid and shy.

In the initial stage, when the disease takes possession of a person, the perception of the world, self-perception, the connection of both are disturbed. In most cases, delusions and hallucinations, obsessive thoughts appear. These symptoms often occur intermittently, waxing and waning. This affects the character of the sick person, it changes - there is thoughtfulness, unwillingness to communicate, a desire for solitude. Questions from loved ones like “What happened?” cause irritation and even aggression. Nevertheless, often the patient manages to hide the growing emotional tension for a long time.

One of the most typical symptoms of the onset of schizophrenia is coldness and aggression towards loved ones, especially towards the mother. Sometimes a delusion of “foreign parents” is formed - the patient is sure that he was adopted, replaced, and somewhere “real” parents are looking for him and waiting, and usually they present themselves as influential and wealthy people.

The prodrome and the stage of mastery are characterized by a disorder of drives. Pyromania, kleptomania, vagrancy, propensity for an antisocial lifestyle, sexual perversions are more noticeable. But attraction disorders can be more refined, such as binge reading syndrome, exploring the city, public transport routes, and the like. For the sake of such hobbies, all the necessary things are abandoned, and all books are read in a row without a system and observance of genres, or a teenager walks around the city / rides public transport all day long, making plans and drawings of an “ideal” settlement, almost the same. Moreover, usually patients cannot clearly explain either the nature of their activities or the meaning of plans and schemes.

The next stage is adaptation. The patient is accustomed to voices, "accepted" his ideas, is confident in his exclusivity, "talent" and so on. He hides from enemies, draws, invents, follows an unfaithful wife, communicates with an alien mind... Delusions and hallucinations become commonplace, two realities, real and illusory, often peacefully coexist in the mind of the patient. In many cases, the disease, which develops smoothly and without acute psychoses, becomes clearly noticeable only at this stage. During this period, painful symptoms are clearly visible, the patient's behavior is already becoming stereotyped - accompanied by the repetition of the same movements, grimaces, gestures, words or phrases (automatisms).

The last stage is degradation (emotional burnout and mental retardation). The duration of the period preceding it differs depending on the type of schizophrenia and the severity of the course. In some mild cases, serious damage to the intellect does not occur at all; in juvenile malignant schizophrenia, the third stage occurs quickly. [11]

Complications and consequences

Schizophrenia is a progressive mental illness. Without treatment, it leads to the loss of the ability to live independently. The patient gradually loses the ability to study, work and earn, the ability to exist in society is impaired.

Men with schizophrenia often drop out of school, work, begin to wander, fall under the influence of asocial elements, they are prone to disorders of drives, in particular - sexual perversions.

Approximately half of schizophrenics abuse psychoactive substances, which aggravates the course of the disease, contributes to an increase in the frequency of relapses, suicidal and violent acts, and brings the development of general mental impoverishment and self-isolation closer. In patients who use toxic substances, resistance to treatment increases, the likelihood of a favorable outcome decreases significantly. In the final stage, alcoholism or drug use may spontaneously stop, however, this indicates an increase in autism.

It is more difficult for schizophrenics to quit smoking, among them there are three times more smokers than among the mentally healthy population. This habit not only has a detrimental effect on the somatic state of the body, but also inhibits the action of antipsychotics, which is why smoking patients need higher therapeutic doses of drugs, which is fraught with the development of side effects.

Schizophrenics are much more likely to be trauma patients than mentally healthy people, their injuries are usually more severe and their mortality is higher.

Patients with schizophrenia often commit suicide, partly in the initial stages of the disease, when they feel that they are losing their mind, partly during the period of advanced delusional disorder, considering themselves unworthy of living. Sometimes they can kill their loved ones out of “the best” intentions in order to “save” them from the coming torment, and then commit suicide, punishing themselves for it.

The social danger of schizophrenics is greatly exaggerated. However, there is a risk. It increases during periods of exacerbations, when there is a high probability of developing psychomotor agitation.

The consequences of the disease are reduced with its later debut. A stable position in society, high professional skills and social activity increase the likelihood of a favorable outcome of treatment and maintaining self-sufficiency.

Diagnostics Schizophrenia in men: causes, types, diagnosis, prognosis

Schizophrenia is diagnosed by the presence of certain clinical symptoms corresponding to this disease, on the basis of complaints from the patient himself, his relatives, and observations in the hospital. In addition, a family history is studied, test studies are carried out to assess the level of mental perception in a patient. The clinical picture of the disease is quite individual and complex, but there must always be a violation of the unity of the thought process, a specific phenomenon of the splitting of the mind, which is present in a schizophrenic from the very beginning. There may not be productive symptoms, however, there is a complete or partial absence of associative connections and clarity of thinking, the ability to purposeful thoughts and actions. One of the central symptoms is alienation and coldness towards the closest people, a monotonous mood, an increase in passivity and a gradual withdrawal from all spheres of active life. Painful schizophreniform manifestations should persist for at least six months. Analyzes and instrumental studies that reliably confirm the diagnosis of schizophrenia are absent and are carried out to distinguish schizophrenia from other diseases in which similar symptoms are observed. [12]

Differential diagnosis

Differential diagnosis is carried out with neuroses and personality disorders (psychopathies), obsessive-compulsive and bipolar disorder , in which the patient comes out of an attack without personality changes, i.e. There is no progression inherent in true schizophrenia.

For example, bipolar disorder with an atypical course strongly resembles recurrent schizophrenia, and both psychoses are quickly stopped by medication, however, the exit from the affective stage of bipolar disorder is characterized by a complete restoration of all personal qualities of the patient, while schizophrenics exit a manic-depressive attack with losses in emotional-volitional sphere and reveal some changes - sociability decreases, the circle of acquaintances narrows, a person becomes more withdrawn, reserved.

Acute polymorphic attacks of schizophrenia are distinguished from infectious, traumatic, post-stroke, intoxication psychoses. Schizophrenia is also differentiated from epilepsy, organic and traumatic brain injuries, chronic consequences of alcoholism and drug addiction. 

Treatment Schizophrenia in men: causes, types, diagnosis, prognosis

Is schizophrenia in men curable? No. Currently, a guaranteed cure is not possible in patients of any gender and age. Refusal to take medication leads to the resumption of attacks of the disease. Therefore, patients receive maintenance therapy for life. In many cases, this allows you to avoid exacerbations for a long period and lead a completely high-quality lifestyle. [13]

Read more about the treatment of schizophrenia in men in this article .

Prevention

Today, there is still no answer to the question of the origin of schizophrenia, so it is impossible to determine preventive measures. You can recommend the above-mentioned eating style, physical activity, rejection of bad habits.

If a person is already sick, then all treatment comes down to preventing exacerbations. Much depends on the patient himself and his environment, their ability to recognize the impending exacerbation in time and take action, their readiness to support and help. [14]

Forecast

Modern medicine has an arsenal of psychotropic drugs and other methods that allow maintaining a fairly active social standard of living for most patients. Schizophrenia in men often begins at an early age and is severe, but even in this case it is difficult to predict the development of events, although in general, a late onset is more favorable prognostically, as is the onset in the form of acute psychosis and obvious symptoms with timely assistance. Aggravating circumstances are alcohol abuse and/or drug addiction.

However, there is an opinion that regardless of the severity of the disease and the type of course, the result of treatment is largely determined by the choice of the patient himself - whether he prefers the real world or the illusory one. If he has something to return to in the real world, he will return.

Employment for patients with schizophrenia seems to be a very difficult, almost impossible task, however, it is not. We are not talking about people who already had a high social status, a job and a certain authority. They usually return to interrupted activities. [15]

In general, the presence of work has a positive effect on the emotional well-being of patients, increases their self-esteem and confidence in the future, takes time and distracts them from socially useful activities. Often people start working part-time, then move on to full-time employment. Much depends on the patient's condition and his ability to perform certain work, to resume education. In most cases, people with schizophrenia, while on maintenance antipsychotic therapy, live a full life and realize their potential. The support of relatives in this case is also invaluable.