Causes of the disease
Often the impetus for the development of the disease is overwork, stress or a prolonged psychologically traumatic situation. Genetic predisposition is of great importance. However, in some people the disease develops against a background of complete mental well-being.
In addition, there are diagnostic criteria, the presence of at least one of which for more than a month makes it possible to establish a diagnosis of schizophrenia.
Criteria according to ICD-10:
• Echo of thoughts.
• Delusion of perception.
• Sound hallucinations.
• Inadequate, ridiculous, delusional, grandiose ideas.
Treatment
Patients are prescribed a range of antipsychotic medications. Social adaptation, communication with the patient, and instilling skills in interacting with other people play an important role in the treatment of the disease. Article 22, part 1, 2 of the Criminal Code of the Russian Federation tells us that a person who suffers from such a disorder is subject to criminal liability.
1. A sane person who, at the time of committing a crime due to a mental disorder, could not fully understand the actual nature and social danger of his actions (inaction) or control them, is subject to criminal liability.
2. A mental disorder that does not preclude sanity is taken into account by the court when assigning punishment and can serve as a basis for imposing compulsory medical measures.
Therapy
In case of neurosis, psychotherapy helps first of all; in rare cases, they resort to the help of psychotropic drugs. They are prescribed for a short period of time and used as maintenance therapy.
Schizophrenia is treated primarily with medication. The drugs are prescribed in long - sometimes even lifelong - courses. Specific psychotherapy is used for intact patients.
anonymous, Male, 26 years old
Hello Igor Evgenievich, I have already tried several times to ask you questions with a sensible description of the problem, but the moderators do not allow my requests to pass through. I hope it works this time. I will try to describe the problem as briefly and concisely as possible. A year ago I suffered from stress, physical discomfort began in the form of pressure in the ears and temples, sleep was disturbed, it became superficial, and frequent awakenings began. I went to see a therapist and a neurologist - I’m healthy everywhere. Then a long-term depersonalization began, gradually the old symptoms went away, new ones appeared - tingling in the arms, legs, etc. I am now working in the far north, there are few qualified specialists, I managed to find only one psychotherapist-psychiatrist. As a result, the doctor diagnosed neurosis and prescribed a course of antidepressants. I did not take them, deciding to deal with the problem myself through exercise and self-soothing. However, further symptoms appeared such as delirium in the head when falling asleep and waking up, for example, “hairy temperature” or when I woke up in the morning I almost called my wife and said that we needed a “northern stroller”. It also seems that a certain stiffness and illogicality of thinking has appeared, and a strong fear of schizophrenia has also appeared. Sometimes delirium or confusion of thoughts may occur briefly during the day. Since there is currently no opportunity to see another doctor, I will ask you whether such symptoms can occur within the framework of neurosis or am I already mentally ill? There were also several awakenings at night, when there was a very difficult to convey feeling - I didn’t understand who I was, where I was, a very restless feeling that you couldn’t formulate a single thought, as if you were deprived of the ability to think, analyze. I really want to visit your clinic when I’m in Moscow, but I can do this on vacation only in 3 months. My question is - is this the beginning of schizophrenia or not?
Hello! Of course, you are not the same as you were - neurotic anxiety changes the perception of reality according to the principle - “fear has big eyes.” But at the same time, you quite rightly noted that the main criterion of normality is your critical attitude to what is happening. You don’t need to be a psychiatrist or have special techniques at your disposal to distinguish a mentally ill (crazy) person from a normal, but suffering neurotic person - as you know, “God forbid we go crazy, it’s better to have a staff and a bag.” Even if you have not had close contact with mentally ill people, you can easily form a collective image of, say, a “city madman” or a typical patient in a psychiatric hospital. You are afraid of becoming like this, but nothing more. If something similar had happened to you, then I would now be answering questions not to you, but to your loved ones, who are concerned about your behavior. It would not bother you at all - you would be sure that everything is fine with you, but those around you form some kind of “conspiracy” against you.
anonymously
Igor Evgenievich, hello again! Thank you very much for your responses to the early consultations. I would like to ask one more clarifying question. I have been taking fluoxetine for a month now as prescribed by a psychotherapist, 1 tablet in the morning. Problems with sleep began and have not gone away to this day - shallow sleep, I sleep a maximum of 5 hours a day, very frequent awakenings. For complaints with sleep, the doctor prescribed half a tablet of Teraligen at night, I don’t feel much effect, frequent awakenings also bother me. Also disturbing is the mental delirium in the morning that I described earlier; when I wake up, the phrases “how to catch a pigeon in a red car”, “crying towel” begin to appear in my head. Once, upon awakening, the flow of such delirium was so strong that, not knowing how to stop it, I began to speak the emerging words out loud. Or yesterday, when waking up, there was an internal dialogue like this: “Am I going crazy? Yes, I'll go. And why? Because I'm special." I’m afraid that I may not understand the boundaries, the nature of these symptoms - it was like a voice in my head or just a drowsy state. Although I really understand that voices in my head are not normal. All this is not imposed by anyone or anything, it happens in my head and these are just my thoughts. This doesn't happen during the day. There are also thoughts that my mind is gradually fading and I am going crazy. Fear that I will soon cease to adequately perceive reality and will not notice it. I had a consultation with two psychiatrists and psychotherapists, they say neurosis, anxiety-neurotic disorder. Previously, he was tested twice by a psychologist for thinking, but no mental abnormalities were identified. Despite this, I’m still afraid that in my case everything is much worse. It seems that I don’t always think logically, even now when typing text I analyze whether I’m constructing sentences logically. There is also intrusive music in my head from time to time. I think I’m doing something wrong, because I take medications and go to doctors. I apologize for the possibly repeated questions, but I hope to receive an answer. Can I realize that I am mentally ill? Is this schizophrenia? In your opinion, is the treatment described above correct in my case? Can you help me?
Hello! You do not become mentally ill, but, unfortunately, you remain highly neurotic. Of course, you can help, but it’s unlikely to be done with fluoxetine, especially in the minimum dosage (20 mg), especially if it’s Russian-made fluoxetine (and not, say, Prozac). In case of severe anxiety, you should choose a selective serotonin with a pronounced anti-anxiety, sedative component of action, and this is not fluoxetine, but rather paroxetine, fluvoxamine, escitalopram, duloxetine.
anonymously
Igor Evgenievich, I wanted to say thank you very much for your answers! I will have two more clarifying questions. The first is at night during one of the awakenings around 4-5 o’clock in the morning, I wake up with a kind of “altered state”, which is difficult to describe. At this moment, fragments of phrases in your head and dialogues are possible. In principle, all my concerns about mental illness lie in this - I wake up, I begin to understand that such a mess is happening in my head, I think that I am really starting to experience signs of psychosis (an altered state, dialogues in my head, fragments of phrases). If you describe this feeling, it’s like suddenly starting to understand that this is it - it’s this uncontrollable feeling of impaired consciousness, as if the world around is starting to distort and you are unable to stop all these processes in your head. I repeat, this does not happen during the day. Is this psychosis? And the second question - on one of the Internet forums I read the story of a girl who was initially described as suffering from neurosis; doctors prescribed her to take antidepressants, which disrupted the “chemical metabolism” and subsequently led to a diagnosis of schizophrenia. Is this possible?
Any altered states of consciousness that occur only in waking states (on the border between sleep and wakefulness) do NOT indicate mental pathology: read, for example, about the so-called. hypnagogic and hypnopompic hallucinations. Taking an antidepressant can NOT lead to schizophrenia. Have you ever heard, read somewhere, or can you imagine that one of the possible or at least probable causes or factors in the development of schizophrenia is “taking antidepressants”?
The neurosis-like form of schizophrenia is one of the most favorable types of the disease with pronounced periods of remission. It belongs to one of the types of sluggish schizophrenia, in 42% of cases it occurs in adolescence. Persistent remissions of the disease are observed in 37% of cases; they last on average from six months to several years. The symptoms of the pathology at the beginning of their development are similar to neurosis, so an important task for treatment is the early diagnosis of schizophrenia.
Examples
1) In March 2006, in the Volgograd region, a criminal case was sent to court against a group of teenagers consisting of four people. They committed two murders in the summer and fall of 2005. The murders they committed were exceptionally ruthless. These teenagers grew up in so-called dysfunctional families, and two brothers also had a personal example of a father convicted of murder. All four, according to experts, were declared insane and released from criminal liability. A forensic psychiatric examination showed that all of them had mental disorders and were in a state of insanity at the time of the crimes. This means that, by court decision, only compulsory medical measures will be imposed, namely, a closed psychiatric institution instead of an educational colony.
If the mental health of a person who has committed a crime is in doubt, then the investigative authorities, the prosecutor's office or the court refer him for a forensic psychiatric examination. Forensic psychiatric examination is the determination of the mental state of the subject in relation to various judicial issues about sanity, legal capacity, the possibility of serving a sentence, as well as the application of certain measures against the insane. Declaring the patient insane excludes his guilt in the crime, and the patient’s action is qualified not as a crime, but as a socially dangerous act. Such patients, by court decision, are sent for compulsory treatment to psychiatric hospitals. When the patient recovers or his condition improves to such an extent that he ceases to be dangerous to society, the patient is examined by a special commission of the hospital, and the conclusion is sent to the court. The court makes a decision to terminate compulsory treatment.
2) Citizen N., together with citizen D., promoted and developed the “theory of public happiness”, according to which modern society needs to be improved by educating a new generation of people not with the help of the old generation, but with the help of specially developed new educational methods that will be used by a select few people-educators. Promoting his ideas, citizen N., with the help of citizen D., created the public organization “B. K.R.” They registered the organization's charter with the justice department of the N region. At the same time, citizen N. took on the role of the chosen educator. The organization had a network of unregistered units in Russia and Ukraine.
Citizen N., together with other persons, began to introduce elements of violence into the so-called “educational” methods, including the increasingly widespread use of physical punishment, as a result transforming the organization into a public association whose activities involve violence against citizens, i.e., an association that encroaches on the personality and rights of citizens, using the previously existing “theory of public happiness”, introducing into it elements of misanthropy and violence.
Citizen N. is recognized as a person who committed the following socially dangerous acts in a state of insanity:
• creation and leadership of an armed formation not provided for by federal law,
• creation of a public association, the activities of which involve violence against citizens and inducing them to commit illegal acts, and the leadership of this association,
• illegal deprivation of liberty of knowingly minors as part of an organized group, with the use of weapons, and torture of minors who were completely dependent on him financially and otherwise.
And citizen D. is recognized as a person who, in a state of insanity, committed a socially dangerous act - participation in an illegal armed group.
According to the report of a forensic psychological and psychiatric examination, citizen N. and citizen D. suffer from chronic mental disorders in the form of schizophrenia. Therefore, during the period relating to their commission of the incriminated acts, they could not realize the actual nature and social danger of their actions and control them.
Citizen N. is exempt from criminal liability for committing socially dangerous acts in a state of insanity, with the use of compulsory medical measures in the form of compulsory treatment in a specialized psychiatric hospital; Citizen D was exempted from criminal liability for committing a socially dangerous act in a state of insanity, with the use of compulsory medical measures in the form of compulsory treatment in a general psychiatric hospital.
3) B. was detained on suspicion of committing a crime - illegal sale of the narcotic drug heroin. Subsequently, B.’s actions were qualified as an attempted sale of the narcotic drug heroin, as well as illegal acquisition and possession of the narcotic drug heroin without the purpose of sale.
During the preliminary investigation, accused B. was assigned and carried out an outpatient forensic psychiatric examination, which came to the conclusion that B. did not realize the actual nature and social danger of his actions and did not direct them during the period of the acts accused of him, i.e. the commission doctors declared him insane.
Based on Art. 21 of the Criminal Code of the Russian Federation (“insanity”), the court released B. from criminal liability for committing acts prohibited by criminal law. The court ordered B. a compulsory medical measure in the form of outpatient compulsory observation and treatment by a psychiatrist at the place of registration.
Insanity eliminates not only the punishment for an act committed in this state, but also criminal prosecution; it excludes the very concept of crime; the acts of an insane person seem to be a case entailing preventive measures, for example, placement in a psychiatric hospital; but these measures are not a consequence of an act committed, but of the discovery of a condition that requires special supervision measures. If it is proven that the person who committed the crime is in a state of insanity, criminal prosecution cannot be initiated, and the one initiated is terminated. Insanity replaces criminal liability with compulsory treatment.
