Schizophrenia in men: symptoms, characteristic signs of behavior

The first signs of schizophrenia are usually perceived by the close environment as eccentricities - a bad mood, impoverishment of emotions, isolation are not specific signs of schizophrenia alone, and indeed of mental illness in general. Moreover, the disease can develop in different forms and at different speeds. If the disease manifests violently and is manifested by acute psychosis, then relatives have no doubt that the mental state requires correction. The patient quickly receives help, and such a development of events is often more favorable than a prolonged gradual increase in the manifestations of negative symptoms - an increase in passivity, emotional and energy deficit. [1]

The main symptoms of psychosis in schizophrenics and other mental illnesses are perceptual delusions or hallucinations; persistent ideas and views that are not related to reality - nonsense; manic and/or depressive affective disorders; movement disorders (catatonia).

Often the first sign of a disease in men is psychomotor agitation, which manifests itself in various forms. Schizophrenia and schizophreniform syndromes are characterized by the following :

• catatonic psychomotor agitation is manifested by constant movements, rhythmic, monotonous, coordination may be impaired, in addition, the patient speaks incessantly - mannerisms, grimaces, mimics others, actions are impulsive, meaningless, repetitive, speech is incoherent, contains rhymes, repetitions of the same words or phrases, the state is accompanied by violent emotions - the patient can be angry, aggressive, pathetic, fall into ecstasy, at times flashes of emotions are replaced by indifference;
• hebephrenic psychomotor agitation is manifested by foolish behavior and senseless impulsive actions, which in many cases are of an aggressive nature;
• manic form - characterized by activity and an irresistible desire for activity, the mood is elevated, actions and ideas are absurd, inconsistent, associative thinking, there may be delusions and hallucinations;
• with psychomotor agitation against the background of hallucinations, the patient is usually concentrated and tense, makes jerky impulsive movements, often of an aggressive or defensive nature, speech is incoherent with threatening intonations;
• when delirious, patients are irritated and vicious, they are distrustful, they can suddenly attack or injure themselves.

But such a bright debut is not always found. Sometimes one of the earliest manifestations of schizophrenia is a change in the character of the patient, this is especially noticeable if he has previously absent features. For example, a noticeable decrease in working capacity, activity, a decrease in interest in activities that were previously loved; a sociable man can become a homebody, stop meeting friends, his girlfriend; his attitude towards his relatives may change - his wife, children, mother, he will become indifferent or even rude and irritable. At the same time, in his free time, he will “get stuck” for a long time in one place with an absent view, just lie or sit on the couch, obviously not doing anything, preferring loneliness to any activity. Such inactivity can relate to different areas: homework and the so-called "going out - to theaters, guests, exhibitions", study or work. The intervals of isolation increase, the man ceases to monitor his appearance - changing clothes, taking a shower, brushing his teeth and clearly prefers his own company.

Violations of the thinking process in schizophrenia and schizophrenia spectrum disorders are expressed in the loss of the sequence of mental activity, its purposefulness and logic. The logical connection between thoughts disappears, they often break off (sperrung), with the course of the disease, the patient is often no longer able to coherently express his thought, which is manifested in the fact that the patient's speech turns into a chaotic set of fragments of phrases that are not connected to each other.

In milder cases, the patient's speech is dominated by a tendency to abstraction and symbolism, unusual and absurd associations appear. Thoughts "slip", the patient, without noticing it, switches from one topic to another. Thought disorders of a schizophrenic are manifested in word creation, "neologisms" are pretentious and understandable only to the patient himself, in fruitless discussions on abstract topics and in the loss of the opportunity to generalize the information received. Mentism is characteristic - an uncontrolled stream of thoughts. Nevertheless, a certain logic, known only to the patient, is observed in statements and actions, and often it is a kind of comprehension and integration of facts that betrays a schizophrenic.

Formally, the level of intelligence in patients, acquired before the illness and in the initial stages, remains intact for a long time, however, over time, cognitive functions are damaged, the ability to compare and analyze facts, plan actions, and communicate in society is impaired, so it becomes more and more problematic for the patient to use the accumulated knowledge. Almost always, difficulties arise in patients when it is necessary to achieve goals and solve issues related to the need to attract new knowledge and skills.

Thought disorders in some cases accompany only periods of relapse, and when the condition stabilizes, they disappear. Some persistent violations of the thought process persist in the latent period, constituting a growing cognitive deficit.

The symptoms of schizophrenia and schizophreniform disorders are quite diverse and can be detected to varying degrees depending on the form and severity of the disease.

In order to raise the question of the diagnosis of "schizophrenia", according to the International Classification of Diseases of the tenth revision, the patient must have at least one so-called "major" symptom or two "small" ones.

One of the following is sufficient:

• the patient's confidence that his thoughts are completely open to reading, that they can be stolen, erased, or, conversely, "put" into the head from the outside (echo of thoughts);
• the patient's confidence that he is controlled from the outside, clearly correlated with actions, movements, thoughts and sensations (delusions of influence and delusional perception);
• auditory hallucinations - one voice or several, coming from different parts of the body, comment on the actions of the patient, give instructions or just communicate;
• the presence of crazy ideas that go against the generally accepted beliefs and rules of behavior for a given society.

Or at least two "minor" symptoms must be present in any combination:

• constant overvalued ideas or any hallucinations - visual images and whole plots, touches, smells, combined with the regular appearance of often incompletely formed delusional ideas, without a pronounced affective component;
• sperrung and mentism, confusion and impoverishment of speech and / or neologisms;
• catatonia, its individual manifestations and other motor disorders;
• thinking disorders - inability to build logical conclusions, generalize, focus on one thought;
• apatoabulic syndrome, impoverishment of emotions, their inadequacy;
• a gradual loss of interest in the outside world and social ties, an increase in passivity and isolation.

Psychotic schizophreniform symptoms should be observed for at least a month in the presence of a long-term (at least six months) decrease in basic human functions related to work, family relationships, and friendships.

Acquired in the process of illness, new disorders (delusions, hallucinations, overvalued ideas) are called productive or positive, emphasizing their addition to the pre-morbid state of the psyche. Autism spectrum disorders, impoverishment of emotions and energy tone are referred to as losses or negative symptoms.

Behavior of a man with schizophrenia

Before the onset of obvious symptoms of schizophreniform disorder, some oddities may be observed in the behavior of a man - a commitment to loneliness, isolation, excessive enthusiasm for certain activities that seem useless to others, long fruitless discussions on selected topics, neglect of appearance, work, study. However, as long as these manifestations do not have the severity of the schizophrenia spectrum disorder, no one will be able to predict its development only by their presence, and even more so, prescribe preventive treatment. Some oddities are inherent in many people who will never get sick with schizophrenia. Such a diagnosis is made according to fairly specific criteria.

However, the success of treatment largely depends on its timely start. The behavior of a man with schizophrenia differs from generally accepted norms even outside of psychosis. Productive symptoms have a great influence on the patient's attitude and, accordingly, behavioral deviations become noticeable. [2]

In the presence of hallucinations, usually auditory, you may notice that your relative often engages in a dialogue with an invisible interlocutor, as if answering questions or commenting on something, often suddenly falling silent and listening. At times you can hear laughter, crying or angry cries. A patient suffering from hallucinations usually has a worried or anxious facial expression that does not correspond to the current situation. It is difficult for him to concentrate on doing a particular job or topic of conversation, as if something is distracting him. In short, it seems that the patient hears (sees, feels) something inaccessible to others. Experts advise in no case to laugh at the patient and obviously not to be afraid of what is happening. It is also not recommended to dissuade the patient of the illusory nature of his sensations and ask in detail about their content. However, you can let him speak if he wants to, and try to convince him to see a doctor. But you need to act as delicately as possible, trying not to hurt the feelings of the patient. Many of them at the initial stage understand the unreality of what is happening, and timely support can help start treatment.

Aggression in schizophrenia in men is most often a manifestation of a delusional disorder. With delirium, the patient becomes suspicious, his distrustful attitude, most often, towards the closest people, is clearly traced. Sometimes, the delirium of influence concerns the life or health of loved ones, then the patient surrounds them with prohibitions and hypertrophied guardianship. Unwillingness to obey the requirements causes aggression in a schizophrenic, in general, any opposition to the patient can cause inadequate anger. The appearance of delirium can be indicated by sudden unreasonable suspicion or hostility, often towards relatives or good friends, sometimes to complete strangers, visible manifestations of fear - carefully locking windows and doors, pulling curtains on the windows, cutting additional locks, checking food for poisoning and other defensive actions. The patient may claim that he is being persecuted, threatened to kidnap himself or loved ones, read his thoughts, or irradiated with invisible rays. The persecutors may be from the realm of fantasy - aliens or foreign intelligence agents. He may become convinced of his own great mission. But sometimes fictional stories are quite realistic - adultery, the intrigues of competitors, complaints about noisy neighbors, their children who harm, damage property, negligent employees that interfere with the implementation of any project, etc.

Often at the same time, a man begins to show negligence in clothes, neglect hygiene. The emotional component is lost, usually the patient cannot empathize with real suffering, however, he does not stop expressing emotions, he can laugh and cry, completely inappropriate, inconsistent with the situation, but with some of his thoughts and feelings. The view of patients becomes inexpressive, turned inward, they are characterized by strange, in the opinion of others, statements, inadequate reactions. Schizophrenics absolutely cannot tolerate criticism of their views, behavior, overvalued ideas and beliefs. No logical conclusions can not convince the patient in his morbid fantasies.

A sudden manic fascination with the occult sciences, religion, esotericism, accompanied by an increasing separation from reality, is also characteristic of schizophreniform disorders.

Motor functions change. In some patients in the prodromal stage, slowness suddenly appears, everything is done with arrangement, accents, for example, things are laid out in a certain order in an apartment or on a table. Arms or legs may begin to tremble from tension. Unusual motor activity - sudden fussiness, more intense facial expressions may also precede the onset of the disease. Schizophrenics are characterized by strange artsy speech, inconsistent, with repetitions, accents, word creation.

The behavior of a man with schizophrenia is not consistent with the current situation, or with life experience, and often with socially accepted standards of behavior. He lives in his own illusory world. For the most part, absolutely meaningless, from the position of a normal person, the actions of a schizophrenic considers the only correct ones, and it makes no sense to convince him. Also, many patients do not recognize themselves as such and do not want to seek help, seeing in persuasion the machinations of ill-wishers. Schizophrenics, despite their apparent amorphousness, are extremely sensitive even to minor events, remarks, and various trifles concerning their fantasies and beliefs. In general, people with a sick psyche are usually selfish, they only care about their own problems that appear in a far-fetched world. Relatives are advised to act carefully, not to put pressure on the patient, not to argue with him, since coercion can cause aggression.

After the start of treatment, most patients quickly become sane. And without treatment, the turn of the so-called negative symptoms comes. Increasing isolation in one's experiences, anxiety, dissociation from the outside world dulls emotions, since there is not enough external information for their production. This is accompanied by abulia - the loss of volitional impulses and motivation for the most elementary actions, and apathy. [3]

Signs of mild schizophrenia in men

As noted above, when the disease manifests itself in the form of a vivid psychosis, there is no doubt that the patient needs the help of a psychiatrist. It is much more difficult to recognize the gradual development of the disease or its mild forms. Sluggish schizophrenia often manifests at a young age, and its first signs coincide with the puberty crisis. At this time, all young people are characterized by the search for the meaning of life, the desire for independence and the associated rejection of authorities, and fascination with various philosophical teachings. Adolescents are rude and irritable, often trying to express themselves, dressing extravagantly or deliberately sloppy, shirk household chores and "start" their studies, so even the closest people may not notice the initial stage of the disease. [4]

But, if you try, you can pay attention to some signs. In schizophrenia, the mutual connections between individual personality characteristics are lost with the complete preservation of intelligence, memory and skills, especially with a mild course of the disease. It can be seen that the feelings and emotions of the patient, from the point of view of a healthy person, do not correspond to external stimuli, the current situation or subjective interests, the same thing happens with thinking and other types of brain activity. All functions are preserved - a person thinks, speaks, listens, gets angry, laughs or cries at something, however, the mutual correspondence of these actions is difficult to catch from the outside.

In mild cases, the patient is diagnosed with schizotypal disorder (previously called sluggish schizophrenia). The patient has oddities in behavior, eccentricity and eccentricity, pretentiousness of speech, pomposity and significance with poverty and inadequacy of intonation, mannerisms of behavior. In general, the same schizophreniform symptoms described above are observed, only in more smoothed forms.

For the early stages, the symptoms of neurosis predominate. The patient often complains of sleep disturbance, obsessive thoughts, philosophizing, "mental chewing gum", a distorted perception of reality, abstract obsessions. Not even every experienced psychiatrist can distinguish the specifics of obsessional components at the beginning. In schizotypal disorder, they are little understood, characterized by a spontaneous character and the rapid development of persistent extremely bizarre rituals. Phobias in patients with schizotypal disorder also quickly become habitual. Talking about them, patients do not express any emotions. Fears are absurd - patients are afraid to see, for example, objects of a certain shape or color, to hear any words uttered by a child, and so on. Sometimes at the beginning it is possible to establish a connection between a phobia and a traumatic event, but over time, its plot becomes more complicated and the origin of fear is erased.

The patient "acquires" ridiculous rituals, they interfere with normal life and sometimes take a leading role in behavior.

With schizotypal disorder, depersonalization / derealization occurs, in particular, dysmorphophobia, and patients are embarrassed by completely normal body parts, hide them, and are embarrassed to show them. If there are real deformities, then the patients ignore them. Hypochondriacal complaints are bizarre and unrealistic, abstruse diets are followed, the goal of which is also not quite typical, for example, so that the face is not round, but oval.

The disease can manifest itself in different ways. Patients are "engaged in scientific work", making useless and incoherent quotations from a variety of literature all day long, which are difficult to even unite with a common theme; draw diagrams and drawings of unclear purpose; develop projects; they talk on global, but very abstract topics, expressing their thoughts incomprehensibly and chaotically, pronounce long monologues, not allowing them to insert a word or ask a question. Some patients put on themselves scientific experiments - they try various toxic substances, lie in a cold bath, and so on. Such "experiments" can end in disability and even death.

With sluggish schizophrenia, both sexes experience frequent hysterical attacks, which are quite strong and not associated with visible stressors. Hysterical attacks are distinguished by deliberate caricature and demonstrativeness, an increase in negativism, unmotivated hyperexcitability. Acting, mannerisms, inadequate grimaces, antics gradually take on a monotonous form, become stereotyped and monotonous, emotional inadequacy, coldness and callousness appear in relation to close people, especially to parents. Negative symptoms develop.

Age features

With the age at which schizophrenia debuted, some, although not at all mandatory, features of its course and treatment prognosis are associated - the later, the easier the disease proceeds and the less destructive its consequences. The most unfavorable prognosis is characterized by hereditary congenital schizophrenia, although such a diagnosis can be made to a child from the age of seven. It is believed that at this age it is already possible to establish the presence of delusions and hallucinations. Experts are trying to find criteria by which schizophrenia can be diagnosed in the smallest. Even babies are supposed to have hallucinations and delusions. [5]

A child with schizophrenia behaves differently from his healthy peers. It is possible to suspect the presence of a disease in the smallest by the manifestation of irrational fear - fear of toys and / or other objects of a certain color, shape, depicting an animal or cartoon character. Babies with schizophrenia are indifferent, and sometimes even wary, of their own mother, who is the most important key figure for a healthy young child. The behavior of a sick child is often inexplicable - he cries, gets angry, is capricious for no apparent reason, and reacts inadequately to attempts to attract his attention.

At a later age, when the baby begins to enter into social contacts with other children and adults, manifestations of obsession, groundless aggression, lack of desire to play with peers, indifference to walks, swings and other favorite children's entertainment attract attention.

A child who has mastered speech can tell parents or older children about the voices that he hears, you can see that he answers them, listens to something. The development of schizophrenia in a child can be indicated by frequent unreasonable mood swings, indifference to the usual activities for children of the appropriate age, chaotic speech, inadequate reactions, endless whims and fears. Parents who have noticed these behavioral features are advised to write down their observations in a diary, then psychiatric consultation will be more effective.

Schizophrenia most often manifests in adolescence, especially its severe forms - simple, catatonic, hebephrenic, both with continuous and with paroxysmal course. In addition, in adolescence, the onset of a low-progressive form of the disease, schizotypal disorder, often occurs. Adolescence is quite complicated in itself and is characterized by high emotional stress, which is probably why the disease most often manifests itself during this period. Moreover, often before the onset of the disease, a teenager does not cause much trouble to parents - he studies diligently, is characterized as serious and obligatory, his behavior is not satisfactory. Suddenly, the young man becomes difficult to control, rude, indifferent to the closest people. He has difficulties with his studies, loses interest in previously favorite activities, but new ones may appear, to which he devotes all his free time. Previously sociable adolescents become isolated, show a tendency to run away from home, use psychoactive substances, become sloppy, suspicious and aggressive.

Signs of schizophrenia in a man of 25, 30, 40, 50 years old have practically no age differences. In adults, the paranoid form most often develops. The development of the disease is gradual, personal changes increase over the years. Characterized by the progression of alienation, secrecy, distrust, caused by the appearance of delirium and hallucinations. When the disease manifests itself at a later age in a person who has managed to take place professionally, have a family and a certain social status, the prognosis in this case is the most favorable.

In old age, schizophrenia rarely develops in men, it progresses slowly. Such cases are much more common in women. Sometimes in older men there is an exacerbation of schizophreniform psychosis, which manifested itself in young years, and as a result of successful treatment, did not manifest itself for a long time. It is not easy to recognize that mental illness is precisely senile schizophrenia, it can be confused with dementia, neurotic disorders, Alzheimer's disease.