What's worse is the diagnosis of f20 or f25. What is paranoid schizophrenia
/ F20 - F29 / Schizophrenia, schizotypal and delusional disorders Introduction Schizophrenia is the most common and important disorder of this group. Schizotypal disorders share many of the characteristics of schizophrenic disorders and appear to be genetically related to them. However, since they do not reveal hallucinatory and delusional symptoms, gross behavioral disturbances inherent in schizophrenia, they do not always attract the attention of doctors. Most delusional disorders do not appear to be associated with schizophrenia, although it can be difficult to differentiate clinically, especially in the early stages. They constitute a heterogeneous and incompletely understood group of disorders, which, for convenience, can be divided, depending on the typical duration, into a group of chronic delusional disorders and a group of acute and transient psychotic disorders. The latter group of disorders is especially common in developing countries. The subdivisions below are to be regarded as preliminary. Schizoaffective disorders are preserved in this section despite conflicting data on their nature.
/ F20 / Schizophrenia
Schizophrenic disorders are generally characterized by fundamental and characteristic disorders of thinking and perception, as well as inadequate or diminished affect. As a rule, clear consciousness and intellectual ability remain, although some cognitive impairment may appear over time. Disorders inherent in schizophrenia affect the fundamental functions that give the normal person a sense of individuality, originality, and purposefulness. Often, the most intimate thoughts, feelings and actions seem to become known to others or shared by them. In such cases, an explanatory delusion may develop that there are natural or supernatural forces that affect, often in a bizarre way, a person's thoughts and actions. Such people can see themselves as the center of everything that happens. Auditory hallucinations that comment on a person's behavior or thoughts are not uncommon. Perception is also often impaired: colors or sounds can appear unusually bright or qualitatively altered, and insignificant features of ordinary things can seem more significant than the whole object or the general situation. Confusion is also common in the early stages of the disease and can lead to the idea that everyday situations have unusual, often ominous, meanings that are intended solely for the individual. A characteristic disorder of thinking in schizophrenia is that insignificant features of a general concept (which are suppressed during normal purposeful mental activity) become predominant and replace those that are more adequate for a given situation. Thus, thinking becomes fuzzy, intermittent and unclear, and speech is sometimes incomprehensible. Thought interruptions and interfering thoughts are also common, and sufferers have a feeling of thought withdrawal. Characterized by a superficial mood with moodiness and inadequacy. Ambivalence and volitional disorders can manifest as inertia, negativism, or stupor. Possible catatonic disorders. The onset of the disease can be acute with severe behavioral disturbances or gradual, with the progressive development of strange ideas and behavior. The course of the disease also reveals a significant variety and in no way means an inevitable chronic development or a growing defect (the course is determined by the fifth sign). In some cases, the frequency of which varies across cultures and populations, recovery may be complete or nearly complete. Men and women get sick about equally often, but women tend to have a later onset of the disease. Although there are no clear pathognomonic symptoms, for practical purposes it is advisable to divide the above symptoms into groups that are important for diagnosis and are often combined, such as: a) echo of thoughts, insertion or withdrawal of thoughts, their broadcasting (openness); b) delusions of influence, influence or passivity, clearly related to movements of the body or limbs or to thoughts, actions or sensations; delusional perception; c) hallucinatory voices, which are a current commentary on the patient's behavior or a discussion of it among themselves; other types of hallucinatory voices emanating from any part of the body; d) persistent delusional ideas of a different kind, which are inadequate for a given social culture and completely impossible in content, such as identifying oneself with religious or political figures, statements of superhuman abilities (for example, the ability to control the weather or communicate with aliens); e) constant hallucinations of any sphere, which are accompanied by unstable or incompletely formed delusional ideas without clear emotional content, or constant overvalued ideas that may appear daily for weeks or even months; f) interruption of thought processes or interfering thoughts, which can lead to disruption or inconsistency in speech; or neologisms; g) catatonic disorders such as agitation, stiffness or waxy flexibility, negativism, mutism and stupor; h) "negative" symptoms such as pronounced apathy, poor speech, smoothness or inadequacy of emotional reactions, which usually leads to social isolation and a decrease in social productivity; it should be obvious that these signs are not due to depression or antipsychotic therapy; i) significant and consistent qualitative change in behavior, which is manifested by a loss of interests, lack of focus, inactivity, self-absorption and social autism. Diagnostic guidelines: A common requirement for diagnosing schizophrenia is the presence of at least one clear symptom (or 2 less distinct symptoms) belonging to group a) - d), or 2 symptoms from e) - i), which should be noted on for most of an episode lasting one month or more. Conditions meeting these requirements but lasting less than a month (regardless of whether the patient was on treatment or not) should be classified as an acute schizophrenic psychotic disorder (F23. 2x) or recoded if symptoms persist for a longer period. Evaluating the condition retrospectively, in some cases it becomes obvious that prodromal phenomena can precede an acute psychotic episode for weeks or even months. Prodromal symptoms include: loss of interest in work, in social activities, in one's appearance, in hygiene habits, which is combined with generalized anxiety, a mild degree of depression. Due to the difficulty of establishing the time of onset of the disease, the one-month-old criterion for the presence of the disorder is relevant only to the aforementioned specific symptoms and not to the prodromal non-psychotic phase. The diagnosis of schizophrenia should not be made in the presence of severe depressive or manic symptoms, unless schizophrenic symptoms have preceded mood disorders. If schizophrenic and affective symptoms develop simultaneously and are evenly presented, a diagnosis of schizoaffective disorder (F25.-) should be made, even if schizophrenic symptoms would justify a diagnosis of schizophrenia. Also, schizophrenia should not be diagnosed in the presence of clear signs of brain disease or in the presence of conditions of drug intoxication or withdrawal. Similar disorders that develop in the presence of epilepsy or other brain diseases should be coded as F06.2x, and those caused by drugs should be coded as F1x.5xx. Course types: The course types of schizophrenic disorders are classified using the following fifth sign: F20.x0 continuous; F20.x1 episodic with a growing defect; F20.x2 episodic with a stable defect; F20.x3 episodic remitting (recurrent); F20.x7 other; F20.x9 observation period less than a year. The presence or absence of a state of remission: The state or absence of remission during observation in a patient and its type is classified by using the following sixth sign: F20.xх4 incomplete remission; F20.xx5 complete remission; F20.xx6 lack of remission; F20.xx8 another type of remission; F20.xx9 remission NOS. Excluded: - acute (undifferentiated) schizophrenia (F23.2x); - cyclic schizophrenia (F25.22); - schizophrenic reaction (F23.2x); - schizotypal personality disorder (F21.8); schizotypal disorder NOS (F21.9)
/F20.0/ Paranoid schizophrenia
It is the most common form of schizophrenia in most parts of the world. The clinical picture is characterized by relatively stable, often paranoid, delusions, usually accompanied by hallucinations, especially auditory, perception disorders. Emotional disorder, volitional and speech disorders, catatonic symptoms are poorly expressed. Examples of the most common paranoid symptoms: a) delusions of persecution, attitude and meaning, high birth, special purpose, bodily change or jealousy; b) hallucinatory voices of a threatening or imperative character or auditory hallucinations without verbal formulation, such as whistling, laughter, humming; c) olfactory or gustatory hallucinations, sexual or other bodily sensations. Visual hallucinations may occur, but they rarely appear as the main symptom. In the acute stages, thought disorders may be pronounced, but they prevent the distinct presence of typical delusional or hallucinatory disorders. The affect is less altered than in other forms of schizophrenia, but some emotional inadequacy and mood disorders such as irritability, sudden anger, fear, and suspicion are common. "Negative" symptoms such as emotional flattening and altered volitional functions are present, but are not leading in the clinical picture. The course of paranoid schizophrenia can be episodic (paroxysmal), code - F20.01x, or chronic (continuous), code - F20.00x. In the latter case, vivid symptoms continue for a number of years and it is sometimes difficult to isolate discrete episodes. The onset of paranoid schizophrenia occurs later than with hebephrenic or catatonic. Diagnostic guidelines: General criteria for schizophrenia (F20.xxx) must be met. In addition, it is necessary to establish the presence of pronounced hallucinations and / or delusions, and changes in emotions, will and speech, catatonic symptoms are relatively poorly expressed. As a rule, hallucinations meet the above criteria b) and c). Delusional disorders can be very diverse, but the most common delusions of exposure and persecution. Differential diagnosis: Epileptic and drug psychoses must be ruled out. It should also be borne in mind that delusions of persecution are not always of great diagnostic value in certain cultural characteristics in some countries. Includes: - paraphrenic schizophrenia; - paranoid schizophrenia with Kandinsky-Clerambo syndrome (hallucinatory and delusional variants); - paranoid schizophrenia with paroxysmal progressive course. Excluded: - end states in paranoid schizophrenia (F20.5xx); - early paranoid schizophrenia (with malignant course) (F20.3xx); - paranoia (F22.01); - paranoid schizophrenia with sensitive delusions of relationships (F22.03); paranoid schizophrenia (F22.82); involutional paranoid state (F22.81)
/F20.1/ Hebephrenic (hebephrenic) schizophrenia
A form of schizophrenia, in which emotional changes are expressed, fragmentation and instability of delusions and hallucinations, irresponsible and unpredictable behavior are noted, mannerism is often found. The affect is shallow and inadequate, often accompanied by giggling, self-righteousness, a self-absorbed smile, stately mannerisms, grimaces, demeanor, leprosy, hypochondriacal complaints, and repetitive expressions. Thinking is disorganized, speech is broken. There is a tendency towards isolation, the behavior is aimless and devoid of emotional coloring. This form of schizophrenia usually begins between the ages of 15-25 and has a poor prognosis due to the rapid onset of "negative" symptoms, especially from flattened affect and loss of urge. In addition, a violation of the emotional sphere and impulses, a disorder of thinking are expressed. Hallucinations and delusions may be present, but these are not the leading symptom. Desire and determination are lost, goals are lost, and thus the patient's behavior becomes aimless and meaningless. Superficial and mannered enthusiasm for religion, philosophy and other abstract theories creates difficulties in following the patient's thoughts. It should be noted: The course of hebephrenic schizophrenia can be episodic (paroxysmal-progressive) (F20.11x) and chronic continuous (F20.10x). Diagnostic instructions: The general criteria for the diagnosis of schizophrenia (F20.xxx) must be met. Usually, hebephrenia should be diagnosed for the first time in adolescence or adolescence. Premorbid patients are usually shy and lonely. For a reliable diagnosis of hebephrenia, it is necessary to monitor the patient for 2-3 months, during which the above behavior persists. Includes: - disorganized schizophrenia; - malignant schizophrenia; - hebephrenia. Excluded: - end-states in malignant schizophrenia (F20.5xx).
/F20.2/ Catatonic schizophrenia
Mandatory and dominant in this form of schizophrenia are psychomotor disorders, which can vary in extreme cases from hyperkinesis to stupor, or from automatic submission to negativism. Forced postures can persist for a long time. Episodes of aggressive behavior can be an important sign of the condition. It should be noted: This description refers to lucid catatonia as a variant of malignant schizophrenia with a continuous (F20.20x) or paroxysmal progressive (F20.21x) course. Catatonic phenomena can be combined with a dream-like (oneiric) state with vivid scene-like hallucinations. It should be noted: This description refers to oneiric catatonia, which occurs in paroxysmal (recurrent) schizophrenia (F20.23x). Diagnostic instructions: General criteria for the diagnosis of schizophrenia (F20.xxx) are required. Isolated catatonic symptoms can occur transiently in the context of any form of schizophrenia. For the diagnosis of catatonic schizophrenia, it is necessary to establish the following forms of behavior in the clinical picture: a) stupor (decreased response to the environment, spontaneous movements and activity) or mutism; b) excitement (involuntary motor activity, not subject to external stimuli); c) freezing (voluntary acceptance and retention of an inadequate or pretentious posture); d) negativism (senseless resistance or movement in the opposite direction in response to all instructions or attempts to change posture or move from place); e) rigidity (holding a rigid posture in response to an attempt to change it); f) waxy flexibility (holding body parts in a given position); g) other symptoms such as automatic submission and perseveration. It must be borne in mind that catatonic symptoms are not diagnostic for schizophrenia. They can also be triggered by brain diseases, metabolic diseases, alcohol or drugs, and also occur with mood disorders. Includes: - lucid catatonia; - oneiric catatonia; - catatonic stupor; - catatonic excitement; - schizophrenic catalepsy; - schizophrenic catatonia; - schizophrenic waxy flexibility.
/F20.3/ Undifferentiated schizophrenia
General diagnostic criteria for schizophrenia (F20.xxx) are needed, but the clinical picture does not fit into any of the above groups or shows signs of several subtypes without a clear dominance of diagnostic characteristics inherent in one of them. This categorization should only be used for psychotic conditions (residual schizophrenia or post-schizophrenic depression should not be included) and only after an attempt has been made to qualify the condition as one of the 3 preceding categories. It should be noted: This code includes polymorphic catatonic-hallucinatory polymorphic delusional and other polymorphic psychotic states. Diagnostic instructions: This subtype should be reserved for those disorders that: a) meet the general criteria for schizophrenia; b) do not meet the criteria for paranoid, hebephrenic or catatonic schizophrenia; c) do not meet the criteria for residual schizophrenia or post-schizophrenic depression. Includes: - early paranoid (malignant) schizophrenia; - atypical schizophrenia. Excludes: - acute schizophreniform psychotic disorder (F23.2x); - chronic undifferentiated schizophrenia (F20.5xx); - end states in malignant schizophrenia (F20.5xx).
/F20.4/ Post-schizophrenic depression
A depressive episode that can be prolonged and occurs as a consequence of schizophrenia. Some schizophrenic symptoms should persist, but they no longer dominate the clinical picture. These persistent schizophrenic symptoms can be positive or negative, although the latter are more common. It has not yet been established, and in general is not essential for the diagnosis, whether the depressive symptoms were only slightly open as a result of the resolution of earlier psychotic symptoms or this is a new symptomatology, whether they are inherent in schizophrenia or are a psychological reaction to it. These conditions are not profound enough to meet the criteria for a major depressive episode (F32.2 and F32.3x). It is often impossible to decide which symptoms are associated with depression and which are associated with antipsychotic therapy, or impaired impulses and flattened affect in schizophrenia. Such depressive conditions are associated with an increased suicidal risk. It should be noted: This variant is considered as a stage in the dynamics of paroxysmal schizophrenia, developing after a psychotic attack (F20.42x). Diagnostic instructions: The diagnosis is established only in the following cases: a) general criteria of schizophrenia (F20.xxx) are determined in the patient; b) some schizophrenic symptoms continue to be present; c) depressive symptoms are leading in the clinical picture, meet the criteria for a depressive episode (F32.xx) and are present for at least 2 weeks.
/F20.5/ Residual schizophrenia
A chronic stage in the course of schizophrenia in which there is a clear transition from an early stage (consisting of one or more episodes with psychotic symptoms that meet the general criteria for schizophrenia) to a subsequent stage characterized by long-term, although not necessarily irreversible, negative symptoms. It should be noted: This code corresponds to the concept of a persistent schizophrenic defect, including the final state in schizophrenia. Diagnostic instructions: For a reliable diagnosis, the following criteria are necessary: \u200b\u200ba) distinct negative schizophrenic symptoms, that is, psychomotor retardation, decreased activity, emotional smoothness, passivity and lack of initiative; poverty of speech, both in content and in quantity; poverty of non-verbal communication (poverty of facial expressions, contact in gaze, voice modulation and posture); lack of self-service skills and social productivity; b) the presence in the past of at least one distinct psychotic episode that meets the criteria for schizophrenia; c) the presence of a period, at least one year, in which the intensity and frequency of vivid symptoms (delusions, hallucinations) would be either minimal or significantly reduced in the presence of negative schizophrenic symptoms; d) no dementia or other brain pathology; lack of chronic depression or hospitalism, which could explain the presence of negative disorders. If it is impossible to obtain a previous anamnesis and, as a result, to find out whether the criteria were consistent with the diagnosis of schizophrenia, then in this case the conditional diagnosis may be residual schizophrenia. Includes: - chronic undifferentiated schizophrenia; - end states in chronic (malignant and paranoid) schizophrenia; - schizophrenic residual state.
/F20.6/ Simple type of schizophrenia
An uncommon disorder in which there is a gradual but progressive development of strange behavior, an inability to meet the requirements of society, and a decrease in overall productivity. Delusional disorders and hallucinations are not noted, and the disorder is not as distinctly psychotic in nature as hebephrenic, paranoid, and catatonic forms of schizophrenia. The characteristic negative signs of residual schizophrenia (that is, flattening of affect, loss of impulses, and so on) develop without prior distinct psychotic symptoms. With increasing social poverty, vagrancy may appear, and the patient becomes self-absorbed, lazy, with no goal. It should be noted: This rubric considers a simple type of schizophrenia as a variant of continuous malignant schizophrenia (F20.60x). Diagnostic guidelines: The diagnosis of simple schizophrenia is made in the presence of progressive development of the disease with characteristic negative symptoms of schizophrenia without pronounced hallucinatory, delusional and catatonic manifestations and with significant changes in behavior, manifested by a pronounced loss of interest, inactivity and social autism. Includes: - a simple variant of malignant schizophrenia; - simplex schizophrenia. Excludes: - "symptom-poor" schizophrenia (F21.5).
/F20.8/ Another type of schizophrenia
Includes: - hypochondriacal schizophrenia; - senestopathic schizophrenia; - children's type of schizophrenia; - schizophreniform psychosis NOS; - schizophreniform disorders NOS. Excludes: - acute schizophrenic disorder (F23.2x); - circular schizophrenia (F25.22); - late paraphrenia (F22.02); - latent schizophrenia (F21.1).
F20.8хх1 Hypochondriacal schizophrenia
F20.8хх2 Senestopathic schizophrenia
F20.8хх3 Children's type of schizophrenia
It should be noted: This subheading includes cases of schizophrenia, manifesting in childhood, characterized by specific age-specific originality and polymorphism of the clinical picture, including cases of schizophrenia arising in early childhood with a pronounced defect of the oligophrenic type. Excluded: - schizophrenia of any established type (F20.0хх - F20.6хх), which arose in childhood.F20.8хх4 Atypical forms of schizophrenia
F20.8хх8 Schizophrenia of other established types
Includes: - schizophreniform psychosis NOS; - schizophreniform disorders NOS.
/F20.9/ Schizophrenia, unspecified
Includes: - schizophrenia NOS.
/ F21 / Schizotypal disorder
This disorder is characterized by eccentric behavior, thinking and emotional abnormalities that resemble those observed in schizophrenia, although at no stage of development is characteristic of schizophrenia observed. There are no prevailing or typical symptoms of schizophrenia. The following signs may be observed: a) inadequate or restrained affect, patients look emotionally cold and detached; b) behavior or appearance - eccentric, eccentric or strange; c) poor contact with others, with a tendency to social isolation; d) strange beliefs or magical thinking that affect behavior and are incompatible with subcultural norms; e) suspicion or paranoid ideas; f) obsessive reflections without internal resistance, often with dysmorphophobic, sexual or aggressive content; g) unusual phenomena of perception, including somatosensory (bodily) or other illusions, depersonalization or derealization; h) amorphous, detailed, metaphorical, hyper-detailed or stereotyped thinking, manifested in strange, pretentious speech or in another way, without pronounced discontinuity; i) episodic transient quasi-psychotic episodes with illusions, auditory or other hallucinations, delusional ideas, arising, as a rule, without external provocation. The disorder is chronic with fluctuations in intensity. Sometimes it results in clear schizophrenia. The exact beginning is difficult to determine, and the course is in the nature of personality disorders. These disorders are more common in individuals genetically related to people with schizophrenia and are believed to be part of the genetic spectrum of schizophrenia. Diagnostic guidelines: Diagnostic rubrics (F21.1. And F21.2.) Are not recommended for widespread use because they are difficult to distinguish from the disorders seen in simple schizophrenia (F20.6xx), or from schizoid or paranoid personality pathologies ... If this term is used, then 3 or 4 of the described typical features should be present constantly or occasionally for at least 2 years. The patient should never show signs of schizophrenia in the past. The presence of schizophrenia in a first-degree relative speaks more in favor of this diagnosis, but is not a necessary prerequisite. It should be noted: The description given is consistent with the picture of latent schizophrenia. This heading includes forms that in the domestic version of ICD-9 were qualified as low-grade or sluggish schizophrenia. Along with the signs listed above, it can manifest itself as persistent obsessive-phobic and / or hysterical, depersonalizing, psychopathic symptoms with features of inertia, monotony, and cliché. For a reliable diagnosis of low-grade schizophrenia, additional signs are required in the form of a decrease in initiative, activity, mental productivity, emotional leveling, and paradoxical judgments. These forms do not meet the diagnostic criteria for overt schizophrenia (F20.xxx). It is also described in the literature as "prepsychotic schizophrenia", "prodromal schizophrenia" and "borderline schizophrenia". Includes: - latent schizophrenia; - latent schizophrenic reaction; - neurosis-like (pseudoneurotic) schizophrenia; - psychopathic (pseudopsychopathic) schizophrenia; - "symptom-poor" schizophrenia; - prepsychotic schizophrenia; - prodromal schizophrenia; - borderline schizophrenia; - schizotypal personality disorder. Excluded: - hypochondriacal schizophrenia (F20.8хх1); - senestopathic schizophrenia (F20.8хх2); schizoid personality disorder (F60.1); - paranoid schizophrenia with sensitive delusions of relationships (F22.03). paranoid schizophrenia (F22.82); Asperger's syndrome (F84.5) F21.1 Latent schizophrenia Includes: - prepsychotic schizophrenia; - prodromal schizophrenia.
F21.2 Schizophrenic reaction
F21.3 Pseudoneurotic
(neurosis-like) schizophrenia
F21.4 Pseudopsychopathic
(psychopathic) schizophrenia
Includes: - Borderline schizophrenia.
F21.5 "Symptomatic" schizophrenia
It should be noted: This form is manifested mainly by negative symptoms, given in the "Diagnostic instructions" for subsection F21. Mental deficiency is expressed at the personal level by signs of growing autism, narrowing of the range of emotional reactions, nuances of interpersonal relationships, decreased productivity, impoverishment of drives and is accompanied by the phenomena of the so-called "asthenic defect" with lethargy, passivity, lack of initiative. Opportunities for social adaptation are limited to basic self-care, performing simple professional duties, and symbiotic coexistence with parents or guardians.F21.8 Schizotypal personality disorder
F21.9 Unspecified schizotypal disorder Includes: - schizotypal disorder NOS./ F22 / Chronic delusional disorders
This group includes various disorders in which chronic delusion is the single or most prominent clinical feature. These disorders cannot be classified as organic, schizophrenic, or affective. Apparently, this group is heterogeneous, with a vague link to schizophrenia. The relative importance of genetic factors, personality characteristics, and life circumstances in lineage is not yet reliable and is very diverse. It should be noted: The codes in this section can be used as a second code to clarify the syndromic characteristics of schizophrenia. For example: a paranoid form of schizophrenia with a continuous course with chronic delusional psychosis is coded by two codes "F20.00x; F22.0x "; or paranoid form of schizophrenia with a continuous course with chronic delusional psychosis with a predominance of hallucinatory disorders is coded" F20.00x; F22.8x ".
/F22.0/ Delusional disorder
A disorder characterized by the development of monothematic or systematic polythematic delusions that are usually chronic and sometimes persist throughout life. The content of delirium is varied. Most often, this is a delusion of persecution, hypochondriac, grandeur, but it can also be querulant, jealous, or a belief is expressed that the patient has an ugly body or that others think that he is emitting a bad smell or that he is homosexual. Other symptoms may not be present, but depressive symptoms may periodically appear, and in some cases, olfactory or tactile hallucinations. Clear, chronic auditory hallucinations ("voices"), schizophrenic symptoms such as exposure delusions, pronounced emotional smoothness, and data that speak for an organic process are incompatible with the diagnosis of delusional disorder. However, especially in elderly patients, the presence of episodic or transient auditory hallucinations does not exclude this diagnosis if the symptoms are not typical for schizophrenia and constitute only a small part of the overall clinical picture. The onset of the disease is usually in middle age, although body dysmorphic disorders can begin at a young age. The content of the delusion, its onset, can often be associated with life circumstances, for example, delusions of persecution among members of national minority groups. In addition to actions and personal attitudes directly related to delirium, affect, speech and behavior do not differ from normal. Diagnostic guidelines: Delirium is the most striking or the only clinical characteristic. He must be present for at least 3 months and be of a personal nature, not subcultural. Depressive symptoms, or even a severe depressive episode (F32.-), may be present intermittently, provided the delirium continues outside the period of the mood disorder. There should be no signs of organic brain pathology or data for schizophrenic symptoms (ideas of influence, transmission of thoughts), auditory hallucinations may occur only occasionally. Includes: - paranoia; - late paraphrenia; - paranoid state; - paranoid schizophrenia with sensitive delusions of relationships; - paranoid psychosis. Excludes: - paranoid personality disorder (F60.0x); - paranoid psychogenic psychosis (F23.3x); - paranoid reaction (F23.3x); - paranoid schizophrenia (F20.0хх).
F22.01 Paranoia
It should be noted: This subheading also includes "paranoid personality development".F22.02 Late paraphrenia
F22.03 Paranoid schizophrenia with sensitive relational delusions F22.08 Other delusional disorders Includes: - paranoid state; - paranoid psychosis. /F22.8/ Other chronic delusional disorders This is a residual category for chronic delusional disorders that do not meet the criteria for delusional disorders (F22.0x). Disorders in which delusions are accompanied by persistent hallucinatory "voices" or schizophrenic symptoms that do not meet the criteria for schizophrenia (F20.-) should be included in this category. Delusional disorders that last less than 3 months should be classified (at least temporarily) in F23.xx. Includes: - involutional paranoid; - a querulant form of paranoia; - a delusional form of dysmorphophobia.F22.81 Involutionary paranoid
F22.82 Paranoid schizophrenia
Includes: - paranoid schizophrenia with qerulatory delusions; - paranoid schizophrenia with litigious delusions; - paranoid schizophrenia with a delusion of invention; - paranoid schizophrenia with delusions of reform; - paranoid schizophrenia with love (erotic) delusions; - paranoid schizophrenia with a delusional form of body dysmorphic disorder. Excludes: - "symptom-poor" schizophrenia (F21.5); - paranoid schizophrenia with sensitive delusions of relationships (F22.03).
F22.88 Other chronic delusional disorders
Includes: - a querulant form of paranoia; - delusional dysmorphophobia; - delusions, fixed on the functioning or appearance of their own body. F22.9 Chronic delusional disorder, unspecified
/ F23 / Acute and Transient Psychotic Disorders
There are no systematic clinical data that could provide definite recommendations for the classification of acute psychotic disorders. The same clinical knowledge and traditions that we are forced to use do not make it possible to formulate a concept and clearly define and delimit these conditions. In the absence of a proven multi-axis system, the method proposed here is an attempt to avoid diagnostic confusion and to create a diagnostic sequence that would reflect the priority characteristics of the disorder. The sequence of priorities is as follows: a) acute onset (within 2 weeks), as a defining feature of the entire group; b) the presence of typical signs; c) the presence of acute stress combined with this state. The classification is designed in such a way that those who disagree with the proposed order of priorities can still identify an acute psychotic disorder with each of these characteristics. In addition, it is recommended, where possible, further subdivision indicating the type of onset for all types of disorders in this group. Acute onset is defined as a transition from a state without psychotic symptoms to a clear pathological psychotic state in 2 weeks or less. There is evidence that a sudden onset is associated with a good outcome, and it is possible that the more abrupt onset, the better the outcome. It is therefore recommended that a sudden onset with a transition to a pathological psychotic state within 48 hours or less be specified and indicated. Typical signs are: 1) a rapidly changing and diverse picture, which is designated as "polymorphic", and which is considered to be the main one in acute psychotic conditions by different authors from different countries; 2) the presence of typical schizophrenic symptoms. The fifth sign may indicate a link with acute stress, which is considered traditional. The limited information that is available does indicate that a significant proportion of acute psychotic disorders occur without stress, so it is possible to indicate its presence or absence. The combination with stress means that the first psychotic symptoms occur within about 2 weeks after one or more events that would be considered stressful for most people in similar situations and in a specific cultural environment for this person. Typical stressful events can include the loss of a loved one, the unexpected loss of a partner, job, divorce, trauma in combat, terrorism and torture. Long-term difficulties or problems should not be included in this section. Full recovery usually occurs within 2 or 3 months, sometimes within weeks or even days. And only a small proportion of patients with such disorders have chronic and disabling conditions. Unfortunately, the current state of our knowledge does not allow us to make an early prognosis concerning that small part of patients who cannot count on a quick recovery. These clinical descriptions and diagnostic guidelines are written in the hope that they can be used by clinicians who need to diagnose and treat patients with a similar condition that has arisen over several days or weeks, without knowing how long it will last. Therefore, items are included indicating the timing of the transition from one state to another. The nomenclature of these acute conditions is as vague as their nosological position, but an attempt has been made to use simple and familiar terms. The term "psychotic disorders" is used for convenience throughout the group, with an additional term indicating the main characteristics in each individual subgroup in the sequence indicated above. Diagnostic guidelines: None of these groups meet the criteria for both manic (F30.-) and depressive (F32.-) episodes, although changes in the affective sphere or individual affective symptoms may be major from time to time. These disorders are also characterized by the absence of organic causes, such as contusion, delirium or dementia. Confusion, concern, and inattention during the conversation are often noted. If these signs are pronounced or long-term, then it is necessary to think about delirium or dementia of an organic nature and the diagnosis should be made after observation. F23.xx disorders (acute and transient psychotic disorders) should also not be diagnosed in the presence of obvious alcohol or drug intoxication, however, minor alcohol or marijuana intake without signs of severe intoxication or disorientation does not exclude the diagnosis of acute psychotic disorder. An important point regarding the 48 hours and 2 weeks criteria is that they do not relate to the maximum severity of the condition, but to the clarity of psychotic symptoms when they interfere with at least some aspects of daily life and work. The highest severity of the condition can be achieved at a later date in both cases; at the indicated time, symptoms only appear and patients have to seek medical help. Prodromal periods of anxiety, depression, social withdrawal, or mildly pathological behavior should not be included in these periods. It should be noted: Code F23.xx "Acute and transient psychotic disorders" there are also cases of paroxysmal schizophrenia, in accordance with domestic classification not suitable under the heading F20.-. When at the same time, an additional fifth character is used for coding: F23.x3 or F23.x4. To clarify the syndromic structure of seizures, the corresponding fourth characters should be indicated: F23.03 or F23.04; F23.13 or F23.14; F23.23 or F23.24; F23.33 or F23.34. If the nosological affiliation of the disease has not been established, then the fifth character is used "0" or "1" only to indicate the presence (or absence) of associated stress. The fifth sign is used to indicate the nosological affiliation of the disease and the relationship between it (or its absence) with acute stress: F23.x0 no associated stress; F23.x1 in the presence of associated acute stress; F23.x2 reactive state; F23.x3 paroxysmal schizophrenia without associated stress; F23.x4 paroxysmal schizophrenia in the presence of associated acute stress; F23.x5 schizophrenic response without associated stress; F23.x6 schizophrenic reaction in the presence of associated acute stress. F23.0x Acute polymorphic psychotic disorder without symptoms of schizophrenia Acute psychotic disorder in which hallucinations, delusions, or perceptual disturbances are obvious, but show marked variability and vary from day to day, or even from hour to hour. Emotional confusion is noted with intense transient feelings of happiness and ecstasy, anxiety and irritability. Polymorphism and instability, a changing clinical picture are characteristic. Although individual affective or psychotic symptoms may be quite obvious, they do not meet the criteria for a manic episode (F30.-), a depressive episode (F32.-), or schizophrenia (F20.-). These disorders often have sudden onset (within 48 hours) and rapid resolution of symptoms. In many cases, there is no distinct provocative stress effect. It should be noted: This description, to a certain extent, corresponds to the development of acute fantastic delirium and acute delirium of staging. If symptoms persist for more than 3 months, the diagnosis should be changed. The most appropriate in such cases would be chronic delusional disorder (F22.-), other inorganic psychotic disorders (F28). Diagnostic guidelines: To make a reliable diagnosis, the following criteria are required: a) acute onset (from a non-psychotic state to a clear psychotic state within 2 weeks or less); b) there must be several types of hallucinations or delusions, which vary in type and intensity from day to day or even during the day; c) there must be an unstable emotional state; d) despite the variety of symptoms, none of them should meet the criteria for schizophrenia (F20.-) or manic (F30.-) or depressive (F32.-) episodes. Includes: - delusional outbreaks without symptoms of schizophrenia; - delusional outbreaks, unspecified; - acute delirium without symptoms of schizophrenia; - acute delirium, unspecified; - cycloid psychosis without symptoms of schizophrenia; - unspecified cycloid psychosis. F23.1x Acute polymorphic psychotic disorder with symptoms of schizophrenia Acute psychotic disorder that meets the criteria for acute polymorphic psychotic disorder (F23.0x), but which additionally has persistent, typical schizophrenic symptoms. Diagnostic guidelines: For a reliable diagnosis, it is necessary to meet the criteria a); b); and c) acute polymorphic psychotic disorders (F23.0x) and additionally the presence of criteria for schizophrenia (F20.xxx), which should be present for most of the time after the establishment of a clear psychotic clinical picture. It should be noted: This condition corresponds to the picture of acute hallucinosis and the syndrome of acute mental automatism (Kandinsky-Clerambo syndrome). If schizophrenic symptoms are present for more than 1 month, then the diagnosis should be changed to schizophrenia (F20.xxx). Includes: - delusional outbreaks with symptoms of schizophrenia; - Acute delirium with symptoms of schizophrenia; - cycloid psychosis with symptoms of schizophrenia. F23.2x Acute schizophreniform (schizophreniform) psychotic disorder Acute psychotic disorder in which the psychotic symptoms are relatively stable and meet the criteria for schizophrenia (F20.-), but which last less than one month. The polymorphic unstable features described in the subheading (F23.0x) are absent. If schizophrenic symptoms persist, the diagnosis should be changed to schizophrenia (F20.-). Diagnostic guidelines: For a reliable diagnosis, the following criteria are required: a) acute onset of psychotic symptoms (2 weeks or less for the transition from a non-psychotic state to a distinct psychotic state); b) criteria for schizophrenia (F20.0хх - F20.3хх) are identified, excluding the criterion of duration; c) there is no compliance with the criteria for acute polymorphic psychotic disorder. It should be noted: This condition corresponds to the picture of an acute polymorphic delusional state with oneiric disorders. If schizophrenic symptoms last more than a month, the diagnosis should be changed to schizophrenia (F20.-). Includes: - acute (undifferentiated) schizophrenia; - oneirofrenia; - schizophrenic reaction; - short-term schizophreniform disorder; - short-term schizophreniform psychosis. Excluded: - organic delusional (schizophrenic) disorder (F06.2x); - schizophreniform disorder NOS (F20.8хх8). F23.3x Other acute predominantly delusional psychotic disorders Acute psychotic disorders in which relatively stable delusions or hallucinations are the main clinical picture, but do not meet the criteria for schizophrenia (F20.-). The most common delusions are persecutory or relationship delusions, and hallucinations are usually auditory ("voices" speak directly to the patient). It should be noted: This condition corresponds to the picture of acute paranoid. Diagnostic guidelines: For a reliable diagnosis, the following criteria are required: a) acute onset of psychotic symptoms (2 weeks or less for the transition from a non-psychotic state to a distinctly psychotic); b) delusions or hallucinations are present most of the time after the establishment of a distinct psychotic state; c) there are no criteria for schizophrenia (F20.-) or acute polymorphic psychotic disorder (F23.0x). If delusions persist for more than 3 months, then the diagnosis should be changed to chronic delusional disorder (F22.-). If only the hallucinations last more than 3 months, then the diagnosis should be changed to inorganic psychotic disorder (F28). Includes: - paranoid reaction; - psychogenic paranoid psychosis; - acute paranoid. F23.8 Other acute and transient psychotic disorders This code classifies any other acute psychotic disorder that is not coded as F23.xx (such as acute psychotic conditions in which clear delusional disorders or hallucinations appear for a short time). States of undifferentiated arousal are also coded in this heading if the absence of organic causes is confirmed or there is no detailed information about the mental state of the patient. Includes: - persecutory hypochondria. F23.9x Acute and transient psychotic disorder, unspecified Includes: - reactive psychosis; - short-term reactive psychosis NOS. F24 Induced delusional disorder A rare delusional disorder that is shared by two or more people with close emotional contact. Only one of this group suffers from a true psychotic disorder; Delusions are induced in other members of the group and usually go away with separation. The psychotic illness in the dominant person is most often schizophrenic, but not always. The dominant person's initial delusions and induced delusions are usually chronic and are, in content, delusions of persecution or grandeur. Delusional beliefs are transmitted in this way only in special circumstances. Typically, the group involved has close contact and is isolated from others by language, culture or geography. The person to whom delusions are induced is most often dependent on or subordinate to a partner with true psychosis. Diagnostic guidelines: The diagnosis of induced delusional disorder can be made if: a) one or two people share the same delusion or delusional system and support each other in this belief; b) they have an unusually close relationship; c) there is evidence that delirium was induced by a passive member of a couple or group by contact with an active partner. Induced hallucinations are rare but do not rule out the diagnosis. However, if there is evidence that two people living together have independent psychotic disorders, none of them should be classified under this heading, even if they share some delusional beliefs. Includes: - conformal delirium; - folie a deux (insanity together); - induced paranoid disorder; - induced psychotic disorder; - symbiotic psychosis. Excludes: - the simultaneous development of psychosis of a non-induced nature (F0x.- - F3x.-). / F25 / Schizoaffective Disorders These are episodic disorders in which both affective and schizophrenic symptoms are expressed, often at the same time, at least for several days. Their relationship to typical mood disorders (F30.- - F39.-) and schizophrenic disorders (F20.-) is not specified. A separate category has been introduced for such disorders as they are too common to be ignored. Other conditions in which affective symptoms overlap or are part of a prior schizophrenic disorder, or coexist, interspersed with other chronic delusional disorders are classified under F20.- - F29. Inappropriate delusional disorders or hallucinations in mood disorders (F30.2x, F31.2x, F31.5x, F32.3x, or F33.3x) do not in themselves justify the diagnosis of schizoaffective disorder. Patients with recurrent schizoaffective episodes, especially those with the manic type rather than the depressive type, usually recover completely. Diagnostic guidelines: The diagnosis of schizoaffective disorder can only be made if both schizophrenic and affective symptoms are expressed simultaneously or sequentially over several days during the same attack, and the attack therefore does not meet the criteria for either schizophrenia or manic or a depressive episode. The term should not be used in cases where schizophrenic symptoms are expressed in some attacks and affective symptoms in others. Quite often, for example, patients with schizophrenia show depressive symptoms as a consequence of a psychotic episode (see post-schizophrenic depression F20.4xx). Some patients suffer from recurrent schizoaffective seizures, which can be either manic, depressive, or mixed. Some people have one or two schizoaffective episodes that are interspersed with typical episodes of mania or depression. In the first case, the diagnosis of schizoaffective disorder would be correct. In the second, the appearance of rare schizoaffective episodes does not remove the diagnosis of bipolar disorder or recurrent depressive disorder, if otherwise the clinical picture is fairly typical. It should be noted: Codes F25.- "Schizoaffective Disorders" denote variants of paroxysmal schizophrenia that are not classified under F20.-. For clarification of the syndromic characteristics of these attacks are used codes F25.01, F25.11, F25.21, F25.22. Includes: - schizoaffective psychosis; - schizophreniform psychosis.
/F25.0/ Schizoaffective disorder,
manic type A disorder in which both schizophrenic and manic symptoms are expressed during the same attack. Mood disorder is expressed in the form of a state with an overestimation of one's own personality, ideas of greatness. However, excitement or irritability is often more pronounced and may be accompanied by aggressive behavior, ideas of persecution. In both cases, there is increased energy, hyperactivity, decreased concentration, loss of normal social inhibition. Delusional ideas of attitude, greatness, or persecution may be noted, but other more typical schizophrenic symptoms are needed to establish a diagnosis of schizophrenia. For example, the patient insists that his thoughts are transmitted to others or interrupted, or outside forces are trying to take control over him. He may claim to hear different voices, or express pretentious, ridiculous delusional ideas that are not solely grandeur or persecution. Careful questioning of the patient can establish whether the patient is really experiencing these painful phenomena, rather than joking or talking in metaphors. Schizoaffective disorders of the manic type are characterized by vivid symptoms with an acute onset. Although the behavior is severely disturbed, complete recovery occurs within a few weeks. Diagnostic guidelines: Elevated mood or a combination of less elevated mood with irritability or agitation should be present. During such an episode, at least one, or preferably two, typical schizophrenic symptoms (F20, -, diagnostic indications a) - d)) must be present. This category is used for a single schizoaffective episode of the manic type or for a recurrent disorder where most episodes are schizoaffective, of the manic type. Includes: - paroxysmal schizophrenia, schizoaffective variant, manic type; - schizoaffective psychosis, manic type; - schizophreniform psychosis, manic type. F25.01 Paroxysmal schizophrenia, schizoaffective variant, manic type F25.08 Other schizoaffective disorder, manic type /F25.1/ Schizoaffective disorder, depressive type A disorder in which both schizophrenic and depressive symptoms are expressed during the course of the illness. Depressive mood is usually accompanied by some depressive traits or behavioral disorder: lethargy, insomnia, loss of energy, loss of weight or appetite, decreased normal interests, impaired concentration, guilt, hopelessness, and suicidal thoughts. At the same time or within the same attack, there are other more typical symptoms of schizophrenia, for example, the patient claims that his thoughts are recognized or interrupted, outside forces are trying to control him. He may claim to be spied on or conspired against him. He hears voices that not only condemn or accuse him, but say that they want to kill him, or discuss his behavior among themselves. Schizoaffective episodes of the depressive type are usually less vivid and disturbing than those of the manic type, but they tend to be more prolonged and have a less favorable prognosis. Although most patients make a complete recovery, some eventually develop a schizophrenic defect. Diagnostic indications: Depression must be expressed with at least 2 characteristic depressive symptoms or concomitant behavioral disorders indicated for depressive episodes (F32.-). Within the same episode, at least one, or preferably two, typical schizophrenic symptoms must be clearly present (see F20.-, diagnostic notes a) - d)). This category should be used when there is a single schizoaffective episode of the depressive type or for a recurrent disorder in which the majority of the episodes are of the schizoaffective depressive type. Includes: - paroxysmal schizophrenia, schizoaffective variant, depressive type; - schizoaffective psychosis, depressive type; - schizophreniform psychosis, depressive type. F25.11 Paroxysmal schizophrenia, schizoaffective variant, depressive type F25.18 Other schizoaffective disorder, depressive type /F25.2/ Schizoaffective disorder,mixed type
This includes disorders in which schizophrenic symptoms (F20.-) coexist with mixed bipolar disorder (F31.6). Includes: - circular schizophrenia; - mixed schizophrenic and affective psychosis. F25.21 Paroxysmal schizophrenia schizoaffective variant, mixed (bipolar) affective type F25.22 Mixed psychosis as a circular variant of paroxysmal schizophrenia Includes: - circular schizophrenia. F25.28 Other schizoaffective condition with mixed bipolar disorder Includes: - mixed schizophrenic and affective psychosis.
F25.8 Other schizoaffective disorders
F25.9 Schizoaffective disorder, unspecified
Includes: - schizophreniform psychosis NOS; - schizoaffective psychosis NOS.
F28 Other nonorganic psychotic disorders
This includes psychotic disorders that do not meet the criteria for schizophrenia (F20.-) or psychotic types of mood disorders (F30.- - F39), and psychotic disorders that do not meet the criteria for chronic delusional disorder (F22.-). Includes: - chronic hallucinatory psychosis NOS. F29 Unspecified inorganic psychosis Includes: - psychosis NOS. Excludes: - mental disorder NOS (F99.9); - organic psychosis, unspecified (F09); unspecified symptomatic psychosis (F09)
Schizophrenia is a serious and mental illness in which emotional disorders, inappropriate behavior, impaired thinking and the inability to lead a social life are observed. Usually develops in men aged 18-25 years and in women aged 26-45 years. Sometimes it is inherited. Risk factors are experiences that have caused stress. Gender doesn't matter. The disease occurs across cultures and affects approximately one in every 100 people worldwide.
Etiology
The term "schizophrenia" is sometimes mistaken for personality disorders. The disease leads to a violation of the person's sense of reality, which is accompanied by inadequacy of his behavior and confusion of emotional reactions. People with schizophrenia can hear voices, which can contribute to strange behavior. They usually need support and constant attention, and are unable to work or maintain relationships with others. Approximately one in ten people diagnosed with schizophrenia commits suicide.
Risk factors
So far, no cause has been identified that causes this disease, but it is known that genetic predisposition plays a role here. In a person who has been in close contact with a schizophrenic patient for a long time, the risk of the disease increases significantly. In addition, stressful experiences, such as serious illness or bereavement, can trigger the development of illness for a person with 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 transferred stress. Sometimes the course of schizophrenia is divided into episodes in which the disease manifests itself clearly, but between which the patient can 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 that no one else 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 he receives bad news);
- incoherent speech, quick transition from one topic of conversation to another;
- deterioration in concentration;
- slowness of movements and thought process;
- anxiety, agitation.
A person with schizophrenia may be depressed, lethargic, and self-absorbed. Perhaps the patient will begin to neglect caring for his own needs, becoming more and more isolated from others.
To help the patient regain organization, may be prescribed. It can take about 3 weeks for a person to get rid of the most obvious symptoms of the disease. Some medicines can cause serious side effects (for example, tremors), in which case their doses may need to be adjusted or other drugs added to reduce this unwanted effect. After the 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 with schizophrenia need to be protected from stressful situations. excitement can lead to symptoms of the disease. They also need frequent and regular contact with social and psychological service workers who monitor their condition.
Counseling psychotherapy can be helpful for both patients and their families. People close to the patient should notice in time the signs of an incipient relapse and indications that the patient is immersed in a general state of apathy and self-neglect.
For most people with schizophrenia, their illness is chronic. However, about one in 5 patients will have a sudden return to normalcy. 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 in order 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.
Paranoid schizophrenia is a debilitating mental illness.
It is also called paranoid schizophrenic disorder.
The main feature of this disease is the loss of connection with the outside world and reality, as a result of which all ability to function and live a full life is lost.
Paranoid schizophrenia can be really exhausting
A disease such as paranoid schizophrenia is referred to as a psychotic disorder.
Among its main symptoms, one most often encounters with auditory hallucinations, as well as deformed thinking.
Often, a person suffering from such an ailment is sure that he is being persecuted and conspired against him. At the same time, he does not lose the ability to concentrate on certain important things, his memory does not deteriorate, and he does not have to deal with emotional apathy.
According to patient descriptions, the course of paranoid schizophrenia appears to them as a struggle against a dark and divided world .
Feelings of suspicion, doubt and isolation dominate such a life. Every day you have to listen to voices inside you even visions are possible.
Here are the symptoms and signs in men and women that can suggest a paranoid form of the disease:
- hearing impairment - a person hears something that is not real;
- developing unexplained anger;
- incoherence of emotions;
- increased anxiety;
- unreasonable agitation;
- aggression and desire to contradict (argue);
- emergence of violent tendencies;
- suicidal tendencies;
- megalomania, overestimated conceit.
However, many of these signs can be observed in other species.
And only hearing impairments and paranoid delusions (hallucinatory-paranoid syndrome) are encountered in the treatment of paranoid schizophrenia.
If you do not start timely treatment of paranoid syndrome in schizophrenia, over time, the violation of the thought process will only intensify. Aggression appears in the patient's behavior: he may even consider it self-defense, since "the whole world is against him" and "we must somehow defend ourselves.".
Sometimes a paranoid schizophrenic begins to feel that he has some special talents, powers or abilities (for example, breathing underwater or flying in the sky).
Or he sincerely considers himself to be some kind of celebrity and, no matter what evidence that refutes such an opinion is presented to him, the patient continues to be convinced of his righteousness.
Negative impact on the human psyche.
One can only imagine how difficult and unpleasant it is to hear voices that others do not hear. These voices are often attuned to criticism, cruel bullying, derision of shortcomings .
Causes and factors
If the symptoms of paranoid schizophrenia are reliably known, researchers are still debating its causes.
True, many agree on the huge role that cerebral dysfunction plays in this pathology. But what factor contributes to this has not yet been revealed.
As a specific risk factor as well as environmental triggers. However, no theory has strong enough evidence to prove it.
Genetic predisposition most often serves as a kind of "switch" that is activated by some event, emotional experience or some other factor.
Factors that increase the likelihood of a diagnosis such as paranoid schizophrenia are:
- the presence of psychotic disorders in one of the relatives;
- viral exposure in the mother's womb;
- lack of nutrients for the fetus;
- getting stress in childhood;
- the result of violence;
- late conception of a child;
- the use of psychotropic substances (especially by adolescents).
And here are the symptoms of the paranoid form of schizophrenic disorder:
- persecution mania;
- a sense of accomplishing a special mission;
- manifestation of aggressive behavior;
- suicidal tendencies;
- the appearance in the head of hallucinatory voices (including imperative ones);
- the possibility of tactile or visual hallucinations.
Paranoid people develop suicidal tendencies
The criteria for diagnosing the disease must correspond to this schizophrenic subtype.
Only the presence of obvious hallucinations and pronounced delirium allows the doctor to diagnose the described disorder, moreover, that:
- practically does not appear;
- emotions and speech are almost not disturbed.
Among delusional states, the most typical are all kinds of persecutory beliefs.
But the development of drug-induced as well as epileptic psychoses, as a rule, is excluded.
It is interesting that there is a definite relationship between the nature of delusion, as one of the symptoms of paranoid schizophrenia, and the level of a person's culture, and even its origin.
Treatment features
What is paranoid schizophrenia, and how is it treated?
Essentially, this is a lifelong commitment, not a temporary treatment course. Although the prognosis is not the most encouraging, it should be considered from the very beginning.
In general, the doctor prescribes therapy based on:
- type of disorder;
- intensity of symptoms;
- individual characteristics of the patient;
- medical history;
- age characteristics;
- other significant factors.
In the treatment process, not only qualified psychotherapists and other medical specialists take an active part, but also the patient's relatives, as well as social workers.
The therapeutic strategy is usually built on:
- taking antipsychotics (traditional and atypical);
- psychotherapeutic procedures;
- electroconvulsive treatment;
- social learning skills.
Treatment for paranoid schizophrenia is often required.
Non-drug, as well as psychotherapeutic intervention is aimed, first of all, at relieving symptoms.
The diagnosis of the disease described can only be made by a qualified physician. Accordingly, the prescription of drugs is carried out by a medical specialist - the same applies to the schedule of drug use and the correct dosage.
If you do not follow the doctor's instructions, the treatment process will not be as effective as we would like, and recovery will not work.
Quite a few people stop taking their medication after the first few months and continue to exhaust the patient with symptoms.
What will happen if you start a disease?
Signs will regularly worsen, and contact with the outside world will be lost. Suicidal thoughts are also amplified, which can lead.
Electroconvulsive therapy is one of the treatment options for paranoid schizophrenia
Often, the patient himself does not notice the strangeness of behavior, and even hallucinations and delusional states take for things that are really happening.
But the people around him (especially close ones) will probably notice the changes and they will most likely have certain suspicions of mental abnormalities - accordingly, they should convince the person to see a doctor.
Disease in ICD-10
Paranoid schizophrenia - what is it in the ICD?
The International Classification of Diseases contains this disorder under the code F20.0.
Along with hallucinations and delusional disorders, the possible presence of affective disorders (anxiety and phobias), catatonic symptoms and speech disorders is assumed.
The following options for the course of the disease are also offered:
- continuous flow - code F20.00;
- an episodic course with a growing defect - code F20.01;
- episodic course with a stable defect - code F20.02;
- the course is progressive, having a paroxysmal character - code F20.03.
In the case of incomplete remission, the code is given F20.04, and with full - F20.05.
That is, the clinical picture of the described disease can be varied.
This directly indicates the multicomponent origin of such a schizophrenic disorder and explains the difficulties associated with the diagnosis.
Aggressive agitation may be one of the first symptoms.
How does the disease begin?
The onset of the disease can be both slow and sudden.
If schizophrenia begins abruptly, the patient's behavior changes rapidly:
- the thought process becomes inconsistent;
- there is aggressive excitement;
- delusional states, characterized by inconsistency, develop;
- development of phobias, that is, causeless fear, is possible;
- behavior becomes more and more strange (inappropriate).
When the onset of the disease is slow, the forms of behavior also change, but not immediately.
From time to time, the patient commits single inappropriate actions, makes strange statements, makes strange grimaces.
Gradually, he loses interest in what previously seemed interesting to him. You can often hear complaints about the feeling of inner emptiness.
Slowly, but steadily, pseudo-neurotic symptoms also grow:
- working capacity decreases;
- the person becomes lethargic and apathetic;
- obsessive desires appear.
The diagnostician's conclusion confirms pseudo-hallucinations, as well as mental automatism (when a person does not perceive his own thoughts and movements as his own).
But it is delusional states that are considered as the main symptom at this stage of the disease.
Prevention
What about prevention of paranoid schizophrenia?
Of course, it is always said that preventive measures are a smarter approach than curative procedures: prevention is better than cure.
But in this case, a certain inability to somehow prevent the development of schizophrenic disorder.
Even if the genetic theory is right, any life event can become the "lever" that will trigger the disease.
The earlier treatment is started, the better the chances of success.
The only thing to remember is the need to start a therapeutic course, without delaying it, and as early as possible. This will help keep the disease under control, helping to improve your long-term prospects.
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Passport part.
FULL NAME:
Gender: male
Date of birth and age: September 15, 1958 (45 years old).
Address: registered in the TOKPB
Cousin's address:
marital status: Not maried
Education: secondary specialized (surveyor)
Place of work: does not work, disabled person of group II.
Date of admission to the hospital: 6.10.2002
ICD referral diagnosis: Paranoid schizophrenia F20.0
Final diagnosis: Paranoid schizophrenia, paroxysmal type of course, with a growing personality defect. ICD-10 code F20.024
Reason for admission.
The patient was admitted to the hospital on 6.10.2002 by ambulance. The patient's cousin turned for help due to his inappropriate behavior, which consisted in the fact that during the week before admission he was aggressive, drank a lot, conflicted with relatives, suspected them that they wanted to evict him, deprive him of his apartment. The patient's sister invited him to visit, distracted his attention by intriguing him with children's photos, and called an ambulance.
Complaints:
1) bad sleep: falls asleep well after taking chlorpromazine, but constantly wakes up in the middle of the night and cannot fall asleep again, does not remember the time of the onset of this disorder;
2) headache, fatigue, weakness, which is associated with both medication intake and an increase in blood pressure (maximum figures - 210/140 mm Hg);
3) forgets first and last names.
4) cannot watch TV for a long time - “eyes get tired”;
5) it is hard to work "leaning", the head is spinning;
6) “cannot do the same thing”;
History of the present disorder.
From the words of relatives, it was possible to find out (by phone) that the patient's condition changed 1 month before hospitalization: he became irritable, actively engaged in "entrepreneurial activity." I got a job as a janitor in a cooperative and collected 30 rubles from the tenants. a month, moonlighted as a loader in a store, and repeatedly took food home. He did not sleep at night, when his relatives asked to see a doctor, he was irritated and left home. An ambulance was called by the patient's cousin, as during the week before admission he became fussy, drank a lot, began to conflict with relatives, accuse them of wanting to be evicted from the apartment. Upon admission to the TOKPB, he expressed certain ideas of the relationship, could not explain the reason for his hospitalization, stated that he agreed to be in the hospital for several days, was interested in the terms of hospitalization, since he wanted to continue working (he did not collect money from everyone). Attention is extremely unstable, speech pressure, speech is accelerated in tempo.
Psychiatric history.
In 1978, while working as the head of a geodetic party, he experienced a pronounced sense of guilt, reaching suicidal thoughts due to the fact that his salary was higher than that of his colleagues, while the duties were less burdensome (in his opinion). However, it did not come to suicide attempts - it stopped love and affection for my grandmother.
The patient considers himself ill since 1984, when he was first admitted to a psychiatric hospital. This happened in the city of Novokuznetsk, where the patient came "to work". He ran out of money and wanted to sell his black leather bag to buy a ticket home, but no one bought it in the market. Walking down the street, he had the feeling that he was being pursued, he "saw" three men who "followed him, wanted to take away his bag." Frightened, the patient ran to the police station and pressed the button to call the policeman. The police sergeant did not notice the surveillance, he told the patient to calm down and returned to the department. After the fourth call to the police, the patient was taken to the department and "began to beat". This was the impetus for the onset of an affective attack - the patient began to fight, scream.
The called psychiatric team took the patient to the hospital. On the way, he also fought with the orderlies. He spent six months in a psychiatric hospital in Novokuznetsk, after which he “independently” (according to the patient) went to Tomsk. At the station, the patient was met by an ambulance team who took him to the regional psychiatric hospital, where he stayed for another year. Of the drugs used for treatment, the patient remembers one aminazine.
According to the patient, after the death of his grandmother in 1985, he left for the city of Biryusinsk, Irkutsk Region, to live there with his own sister. However, during one of the quarrels with his sister, something happened (the patient refused to clarify), which led to a miscarriage by the sister and hospitalization of the patient in a psychiatric hospital in Biryusinsk, where he spent 1.5 years. It is difficult to indicate the treatment carried out.
It should be noted that, according to the patient, he "drank a lot, sometimes there was too much."
The next inpatient admissions were in 1993. According to the patient, during one of the conflicts with his uncle, in a fit of anger, he told him: "Or you can use a hatchet on the head!" My uncle was very scared and therefore "deprived me of my registration." Afterwards, the patient regretted very much about the words he had spoken, repented. The patient believes that it was the conflict with the uncle that caused the hospitalization. In October 2002 - a real hospitalization.
Somatic history.
He does not remember childhood diseases. She notes a decrease in visual acuity from grade 8 to (-) 2.5 diopters, which persists to this day. At the age of 21, he suffered an open form of pulmonary tuberculosis, was treated in a tuberculosis dispensary, does not remember the drugs. The last five to six years have marked periodic increases in blood pressure up to maximum figures of 210/140 mm. rt. Art., accompanied by headache, tinnitus, flashing flies. He considers the numbers of HELL 150/80 mm as usual for himself. rt. Art.
In November 2002, while in the hospital, he suffered acute right-sided pneumonia, and received antibiotic therapy.
Family history.
Mother.
The patient's mother does not remember well, since she spent most of the time in hospital at the regional psychiatric hospital (according to the patient, she suffered from schizophrenia). She died in 1969, when the patient was 10 years old, she does not know the cause of her mother's death. His mother loved him, but could not significantly influence his upbringing - the patient was brought up by his mother's grandmother.
Father.
The parents divorced when the patient was three years old. After that, my father left for Abkhazia, where he started a new family. The patient met with his father only once in 1971 at the age of 13; after the meeting, painful, unpleasant experiences remained.
Sibs.
The family has three children: an older sister and two brothers.
The older sister is an elementary school teacher, lives and works in the city of Biryusinsk, Irkutsk region. Does not suffer from mental illness. The relationship between them was good, friendly, the patient says that he recently received a postcard from his sister, showed it.
The patient's middle brother has been suffering from schizophrenia since the age of 12, a disabled person of the II group, is constantly being treated in a psychiatric hospital, at the present time the patient knows nothing about his brother. Before the onset of the disease, relations with my brother were friendly.
The patient's cousin is also currently admitted to the hospital for schizophrenia.
Other relatives.
The sick man was raised by his grandparents, as well as his older sister. He has the most tender feelings for them, speaks with regret of the death of his grandparents (grandfather died in 1969, grandmother in 1985). However, the choice of profession was influenced by the patient's uncle, who worked as a surveyor and topographer.
Personal history.
The patient was a welcome child in the family, there is no information about the perinatal period and early childhood. Before entering the technical school, he lived in the Chegara village of the Parabelsky district of the Tomsk region. Of friends, he remembers "Kolka", with whom he is still trying to maintain relations. Preferred games in the company, smoked since 5 years. I went to school on time, I loved mathematics, physics, geometry, chemistry, in other subjects I got "C's" and "C's". After school I went to drink vodka with my friends, the next morning I was sick with a hangover. In the company he showed striving for leadership, was a "ringleader". During fights, he experienced a physical fear of pain. The grandmother did not bring up her grandson very strictly, she did not use physical punishment. The object to follow was the patient's own uncle, a surveyor-topographer, who subsequently influenced the choice of profession. After finishing 10 classes (1975) he entered the geodetic technical school. He studied well at the technical school, he loved his future profession.
He strove to be in a team, tried to maintain good relations with people, but had difficulty controlling his feelings of anger. I tried to trust people. "I believe a person up to three times: if he deceives me, I will forgive, the second time he deceives, I will forgive, the third deceives me, I will already think what kind of person he is." The patient was absorbed in work, the mood was good and optimistic. There were difficulties in communicating with girls, but the patient does not talk about the reasons for these difficulties.
I started working at the age of 20 in my specialty, I liked my job, there were good relations in the work collective, I held small managerial positions. He did not serve in the army due to pulmonary tuberculosis. After the first hospitalization in a psychiatric hospital in 1984, he changed his place of work many times: he worked as a salesman in a bakery store, as a janitor, and washed porches.
Personal life.
He was not married, at first (before the age of 26) he considered it “too early”, and after 1984 he did not marry for the reason (according to the patient) - “what's the use of fools?”. He did not have a permanent sexual partner, he is wary of the topic of sex, refuses to discuss.
Relation to religion.
He showed no interest in religion. However, recently he began to recognize the presence of a "higher power", God. Considers himself a Christian.
Social life.
He did not commit criminal acts, he was not brought to court. I did not use drugs. Smokes since 5 years, later - 1 pack a day, recently - less. Before hospitalization, he actively consumed alcohol. He lived in a two-room apartment with his niece, her husband and child. He loved to play with the child, look after him, maintained good relations with his niece. Conflicted with the sisters. The last stress - a quarrel with a cousin and uncle before hospitalization about an apartment, is still going through. In the hospital, no one visits the patient, relatives ask doctors not to give him the opportunity to call home.
Objective history.
It is impossible to confirm the information received from the patient due to the absence of the patient's outpatient card, archival medical history, contact with relatives.
Somatic status.
The condition is satisfactory.
The physique is normosthenic. Height 162 cm, weight 52 kg.
The skin is of a normal color, moderately moist, turgor is preserved.
Visible mucous membranes of normal color, pharynx and tonsils are not hyperemic. Tongue moist, whitish coating on the back. The sclera are subicteric, conjunctival hyperemia.
Lymph nodes: submandibular, cervical, axillary lymph nodes 0.5 - 1 cm in size, elastic, painless, not soldered to the surrounding tissues.
The thorax is normosthenic, symmetrical. The supraclavicular and subclavian fossa are retracted .. Intercostal spaces are of normal width. The sternum is unchanged, the epigastric angle is 90.
The musculature is developed symmetrically, to a moderate degree, normotonic, the strength of the symmetrical muscle groups of the limbs is preserved and the same. There is no pain during active and passive movements.
Respiratory system:
Lower boundaries of the lungs
Right left
Substernal line V intercostal space -
Midclavicular line VI rib -
Anterior axillary line VII rib VII rib
Mid axillary line VIII rib VIII rib
Posterior axillary line IX rib IX rib
Scapular line X rib X rib
Paravertebral line Th11 Th11
Auscultation of the lungs With forced expiration and calm breathing with auscultation of the lungs in the clinically and orthostatic position, breathing over the peripheral parts of the lungs is rigid vesicular. Dry "crackling" rales are heard, equally pronounced on the right and left sides.
The cardiovascular system.
Percussion of the heart
Boundaries of the relative dullness of the absolute dullness
Left Along the midclavicular line in the V intercostal space Medially 1 cm from the midclavicular line in the V intercostal space
Upper III rib Upper edge IV rib
Right IV intercostal space 1 cm outward from the right edge of the sternum In the IV intercostal space along the left edge of the sternum
Auscultation of the heart: the sounds are muffled, rhythmic, no side murmurs were detected. Accent II tone on the aorta.
Arterial pressure: 130/85 mm. rt. Art.
Pulse 79 beats / min, satisfactory filling and tension, rhythmic.
Digestive system.
The abdomen is soft, painless on palpation. There are no hernial protrusions and scars. The muscle tone of the anterior abdominal wall is reduced.
Liver along the edge of the costal arch. The edge of the liver is pointed, even, the surface is smooth, painless. Dimensions according to Kurlov 9: 8: 7.5
Symptoms of Kera, Murphy, Courvoisier, Pekarsky, and the phrenicus symptom are negative.
The stool is regular, painless.
Genitourinary system.
Pasternatsky's symptom is negative on both sides. Urination is regular, painless.
Neurological status.
There were no injuries to the skull or spine. The sense of smell is preserved. The eye slits are symmetrical, the width is within normal limits. The movements of the eyeballs are in full, the nystagmus is horizontal shallow.
Facial skin sensitivity is within normal limits. There is no facial asymmetry; nasolabial folds and corners of the mouth are symmetrical.
Tongue in the middle line, taste preserved. Hearing disorders were not identified. The gait with open and closed eyes is smooth. In the Romberg position, the position is stable. Finger test: no mimicking. There are no paresis, paralysis, or muscle atrophy.
Sensitive area: Pain and tactile sensitivity in the hands and body is preserved. The musculoskeletal feeling and the feeling of pressure on the upper and lower limbs are preserved. Stereognosis and two-dimensional spatial sense are preserved.
Reflex sphere: reflexes with the biceps and triceps muscles of the shoulder, knee and Achilles are preserved, even, slightly revitalized. The abdominal and plantar reflexes were not studied.
Sweating of the palms. Dermographism is red, unstable.
Severe extrapyramidal disorders were not identified.
Mental status.
Below average height, asthenic constitution, dark skin, black hair with light gray, the appearance corresponds to age. He takes care of himself: he looks neat, neatly dressed, his hair is combed, the nails are clean, shaved clean. The patient makes contact easily, talkative, smiling. Consciousness is clear. Oriented in place, time and self. During the conversation, he looks at the interlocutor, showing interest in the conversation, gestures a little, the movements are fast, somewhat fussy. He is distant with a doctor, friendly in communication, willingly talks on various topics concerning his many relatives, speaks positively of them, except for his uncle, whom he took an example from and admired, but later began to suspect of a bad attitude towards himself, the desire to deprive his living space. He speaks about himself selectively, almost does not reveal the reasons for hospitalization in a psychiatric hospital. During the day, he reads, writes poetry, maintains good relations with other patients, and helps the staff in working with them.
Perception. Perceptual disorders have not been identified at the moment.
The mood is even, he smiles during the conversation, says that he feels good.
Speech is accelerated, verbose, articulated correctly, and phrases are grammatically correct. Spontaneously continues the conversation, slipping on extraneous topics, developing them in detail, but not answering the question asked.
Thinking is characterized by thoroughness (a lot of insignificant details, details not related to the directly asked question, the answers are lengthy), slippage, and the actualization of secondary signs. For example, to the question "Why did your uncle want to deprive you of your registration?" - answers: “Yes, he wanted to remove my stamp in the passport. You know, the registration stamp, it is so rectangular. What is yours? I had my first registration in ... year at ... address. " The associative process is characterized by paralogism (for example, the task "excluding the fourth superfluous" from the list "boat, motorcycle, bicycle, wheelbarrow" excludes the boat on the principle of "no wheels"). He understands the figurative meaning of proverbs correctly, he himself uses them in his speech for the intended purpose. Substantial thinking disorders are not detected. It is possible to concentrate attention, but we are easily distracted, cannot return to the topic of conversation. Short-term memory is somewhat reduced: he cannot remember the name of the curator, the test “10 words” does not reproduce completely, from the third presentation of 7 words, after 30 minutes. - 6 words.
The intellectual level corresponds to the education received, the way of life, which is filled with reading books, writing poetry about nature, about mother, death of relatives, about one's life. Poems are sad in tone.
Self-esteem is reduced, considers himself inferior: when asked why he didn’t get married, he replies, “What's the use of making fools?”; his criticism is incomplete with regard to his illness, I am convinced that at present he no longer needs treatment, he wants to go home, work, and receive a salary. He dreams of going to his father in Abkhazia, whom he has not seen since 1971, to give him honey, pine nuts and so on. Objectively, the patient has nowhere to return, as his relatives deprived him of his registration and sold the apartment in which he lived.
Qualification of mental status.
The patient's mental status is dominated by specific thinking disorders: slippage, paralogism, actualization of secondary signs, thoroughness, attention disorders (pathological distraction). Criticism to their condition is reduced. Makes unrealistic plans for the future.
Laboratory data and consultations.
Ultrasound examination of the abdominal organs (18.12.2002).
Conclusion: Diffuse changes in the liver and kidneys. Hepatoptosis. Suspected duplication of the left kidney.
Complete blood count (15.07.2002)
Hemoglobin 141 g / l, leukocytes 3.2x109 / l, ESR 38 mm / h.
The reason for the increase in ESR is possibly the premorbid period of pneumonia diagnosed at this time.
General urine analysis (15.07.2003)
The urine is clear, light yellow. Sediment microscopy: leukocytes 1-2 in the field of view, single erythrocytes, crystalluria.
Justification of the diagnosis.
Diagnosis: "paranoid schizophrenia, the type of course is episodic with a growing defect, incomplete remission", ICD-10 code F20.024
Delivered on the basis of:
Medical history: the disease began acutely at the age of 26, with delusions of persecution, which led to hospitalization in a psychiatric hospital and required treatment for a year and a half. The plot of nonsense: "three young men in black jackets are watching me and want to take away the black bag that I want to sell." Subsequently, the patient was hospitalized several times in a psychiatric hospital due to the appearance of productive symptoms (1985, 1993, 2002). During periods of remission between hospitalizations, he did not express delusional ideas, there were no hallucinations, however, the disturbances in thinking, attention and memory characteristic of schizophrenia persisted and progressed. During admission to the hospital, the patient was in a state of psychomotor agitation, expressed some delusional ideas of the relationship, said that "his relatives want to evict him from the apartment."
Family history: heredity is burdened by schizophrenia on the part of the mother, brother, cousin (undergoing treatment at the TKPB).
Actual mental status: the patient has persistent thinking disorders, which are obligate symptoms of schizophrenia: thoroughness, paralogism, slippage, actualization of secondary signs, uncriticality to their condition.
Differential diagnosis.
Among the range of suspected diagnoses when analyzing the mental status in this patient, one can assume: bipolar affective disorder (F31), mental disorders due to organic brain damage (F06), among acute conditions - alcoholic delirium (F10.4) and organic delirium (F05).
Acute conditions - alcoholic and organic delirium - could be suspected in the first time after hospitalization of the patient, when fragmentary delusional ideas of attitude and reform were expressed to them, and this was accompanied by activities adequate to the expressed ideas, as well as psychomotor agitation. However, after the relief of acute psychotic manifestations in the patient against the background of the disappearance of productive symptoms, obligate symptoms characteristic of schizophrenia remained: disturbances in thinking (paralogism, low productivity, slipping), memory (fixation amnesia), attention (pathological distraction), sleep disturbances persisted. There were no data for the alcoholic genesis of this disorder - withdrawal symptoms, against the background of which delirious clouding of consciousness usually occurs, data on massive alcoholization of the patient, characteristic of undulating delirium and perception disorders (true hallucinations). Also, the lack of data on any organic pathology - previous trauma, intoxication, neuroinfection - in a place with a satisfactory somatic state of the patient makes it possible to exclude organic delirium during hospitalization.
Differential diagnosis with organic mental disorders, in which there are also disorders of thinking, attention and memory: there are no data for traumatic, infectious, toxic damage to the central nervous system. The patient has no psychoorganic syndrome, which forms the basis of the long-term consequences of organic brain lesions: there is no increased fatigue, severe autonomic disorders, and no neurological symptoms. All this, coupled with the presence of disorders of thinking and attention characteristic of schizophrenia, makes it possible to exclude the organic nature of the observed disorder.
To differentiate paranoid schizophrenia in this patient with a manic episode within the framework of bipolar affective disorder, it is necessary to remember that the patient was diagnosed with a hypomanic episode within the framework of schizophrenia during hospitalization (there were three criteria for hypomania - increased activity, increased talkativeness, distraction and difficulty concentrating) ... However, the presence of delusions of attitudes, disorders of thinking and attention, uncharacteristic for a manic episode in affective disorder, casts doubt on such a diagnosis. Paralogism, slippage, unproductive thinking, remaining after the relief of psychotic manifestations, rather testify in favor of a schizophrenic defect and hypomanic disorder than in favor of an affective disorder. The presence of a follow-up history for schizophrenia also makes it possible to exclude such a diagnosis.
Rationale for the treatment.
Prescribing antipsychotics for schizophrenia is a mandatory component of drug therapy. Given the history of delusional ideas, the patient was prescribed a prolonged form of selective antipsychotic (haloperidol-decanoate). Given the tendency to psychomotor agitation, the patient was prescribed a sedative neuroleptic chlorpromazine. The central M-anticholinergic antagonist cyclodol is used to prevent the development and reduce the severity of side effects of antipsychotics, mainly extrapyramidal disorders.
Supervision diary.
10 September
t˚ 36.7 pulse 82, BP 120/80, NPV 19 per minute Getting to know the patient. The patient's condition is satisfactory, complaints of insomnia - he woke up three times in the middle of the night, walked around the department. The mood is depressed due to the weather, thinking is unproductive, paralogous with frequent slippage, and thorough. In the area of \u200b\u200battention - pathological distraction Haloperidol decanoate - 100 mg / m (injection from 4.09.2003)
Aminazine - per os
300mg-300mg-400mg
Lithium carbonate per os
0.6 - 0.3 - 0.3g
Cyclodol 2 mg - 2 mg - 2 mg
11 September
t˚ 36.8 pulse 74, BP 135/75, NPV 19 per minute The patient's condition is satisfactory, complaints of poor sleep. The mood is even, there are no changes in the mental status. The patient is sincerely happy with the notebook given to him, with pleasure he reads the poems written by him aloud. Continuation of the treatment prescribed on September 10
September 15th
t˚ 36.6 pulse 72, blood pressure 130/80, NPV 19 per minute The patient's condition is satisfactory, no complaints. The mood is even, there are no changes in the mental status. The patient is glad to meet you, reads poetry. Tachyphrenia, speech pressure, slippage up to breaking of thinking. Not able to exclude the fourth unnecessary item from the presented sets. Continuation of the treatment prescribed on September 10
Expertise.
Labor expertise The patient was recognized as a disabled person of the II group, re-examination in this case is not required, given the duration and severity of the observed disorder.
Forensic examination. Hypothetically, in case of committing socially dangerous acts, the patient will be declared insane. The court will decide on a simple forensic psychiatric examination; taking into account the severity of the existing disorders, the commission may recommend compulsory inpatient treatment at TKPH. The final decision on this issue will be made by the court.
Military expertise. The patient is not subject to conscription into the armed forces of the Russian Federation due to the underlying disease and age.
Forecast.
In the clinical aspect, it was possible to achieve partial remission, reduction of productive symptoms and affective disorders. The patient has factors that correlate with a good prognosis: acute onset, the presence of provoking moments at the onset of the disease (dismissal from work), the presence of affective disorders (hypomanic episodes), late age of onset (26 years). Nevertheless, the prognosis in terms of social adaptation is unfavorable: the patient does not have housing, his connections with relatives are broken, persistent disorders of thinking and attention persist, which will interfere with work in the specialty. At the same time, the patient's elementary labor skills are preserved, he is happy to participate in nosocomial labor activities.
Recommendations.
The patient needs continuous long-term treatment with selected drugs in adequate dosages, which the patient has been treated with for a year. The patient was recommended to stay in a hospital due to the fact that his social ties are broken, the patient does not have his own place of residence. The patient is shown therapy with creative self-expression according to M.E. Stormy, occupational therapy, as he is very active, active, wants to work. Recommended work activity is anything other than intellectual. Recommendations to the doctor - work with the patient's relatives to improve the patient's family ties.
Used Books.
1. Avrutskiy G.Ya., Neduva A.A. Treatment of the mentally ill (Guide for physicians) .- M .: Medicine, 1981.-496 p.
2. Bleikher V.M., Kruk I.V. Explanatory Dictionary of Psychiatric Terms. Voronezh: Publishing house NPO "MODEK", 1995.-640 p.
3. Vengerovsky A.I. Lectures on pharmacology for doctors and pharmacists. - Tomsk: STT, 2001.-576 p.
4. Gindikin V.Ya., Gurieva V.A. Personal pathology. M .: "Triada-X", 1999.-266 p.
5. Zhmurov V.A. Psychopathology. Part 1, part 2. Irkutsk: Publishing house Irkut. University, 1994
6. Korkina M.V., Lakosina N.D., Lichko A.E. Psychiatry. Moscow - "Medicine", 1995. - 608 p.
7. Lecture course on psychiatry for students of the medical faculty (lecturer - candidate of medical sciences, associate professor S.A. Rozhkov)
8. Workshop on psychiatry. (Educational-methodical manual) / compiled by: Eliseev A.V., Raizman E.M., Rozhkov S.A., Dremov S.V., Serikov A.L. under the general editorship of prof. Semina I.R. Tomsk, 2000.- 428 p.
9. Psychiatry \\ Ed. R. Shader. Per. from English. M., "Practice", 1998.-485 p.
10. Psychiatry. Uch. pos. for stud. honey. university. Ed. V.P. Samokhvalova .- Rostov n \\ D .: Phoenix, 2002.-576 p.
11. Guide to Psychiatry \\ Ed. By A.V. Snezhnevsky. - T.1. M .: Medicine, 1983.-480 p.
12. Churkin A.A., Martyushov A.N. A brief guide to the use of ICD-10 in psychiatry and narcology. Moscow: "Triada-X", 1999.-232 p.
13. Schizophrenia: multidisciplinary research \\ edited by A. Snezhnevsky. M .: Medicine, 1972.-400 p.