Neurosis-like (pseudo-neurotic) schizophrenia

Pseudoneurotic schizophrenia
or
neurosis-like schizophrenia
is a form of schizophrenia manifested by symptoms reminiscent of neurosis (phobias, depersonalization, obsessions (obsessions), subdepression, hypochondria) [1].

Basic Description

The difference between pseudoneurotic schizophrenia and neuroses is that the symptoms are not associated with a traumatic situation or premorbid personality characteristics [1]. Manifestations of the disease occur suddenly and increase over time, that is, a progressive course is characteristic[1]. Obsessions in pseudoneurotic schizophrenia are illogical; patients may be afraid, for example, that “teeth will fall into the gums” or “blood will clot in the vessels”[1].

N.I. Felinskaya (1979) described a characteristic combination of neurasthenia-like symptoms with dysmorphophobia and obsessions, and obsessions with hypochondria [3]. In this case, neurosis-like syndromes often do not correspond to the premorbid characteristics of patients; with asthenic complaints, there is an absence of phenomena of increased exhaustion, asthenic-like states are difficult to distinguish from increasing apathy [3].

Who can help in this situation?

First on the list of people who can solve the problem of both neurosis and neurosis-like schizophrenia are doctors. In particular, this is a therapist and a psychiatrist, in addition, sometimes a consultation with a narcologist is required.

If the cause of a mental disorder was drug use, then only a narcologist will be able to draw a correct picture of the disease and determine a treatment regimen. During the first visit to a specialist, the patient will need to answer several questions. The conversation will concern the use of drugs and alcohol, the situation in the family, at work or at school. The data (subsequently analyzed by a psychiatrist) will help confirm or refute the presence of the disease and detect the cause if mental pathology does occur. In addition, during the consultation the patient will be asked to undergo psychological tests and examination using special devices. Only after final processing of the results will it be possible to prescribe treatment.

The group of “helpers” includes relatives and friends of a person suffering from mental disorders. Sincere support will help you quickly achieve a period of stable remission and return to a more or less normal life. This is especially important if the patient is a teenager. Teenagers are much more impulsive than adults, so being overexcited can trigger suicide. Relatives must constantly monitor the behavior of a person with neurosis-like schizophrenia, if only because of such a serious risk. Love and support are the best way to help stabilize the patient’s condition, help him leave his closed world and establish contact with others.

It is important to understand that pseudoneurotic (neurosis-like) schizophrenia is just as dangerous as the “classic” form of schizotypal disorder. The presence of hallucinations and “voices in the head” can provoke the patient to cause harm to himself or others.

Therapy

Antipsychotics and antidepressants are used for treatment. An open study showed [ the significance of the fact?

] that the long-acting antipsychotic risperidone (Rispolept Konsta) stabilized the condition of those suffering from pseudoneurotic schizophrenia and reduced the severity of symptoms (a reduction in the manifestations of cognitive anxiety and hypochondriacal involvement was observed in patients with anxiety-phobic and anxiety-hypochondriasis syndrome, a reduction in episodic outbreaks of anxiety in patients with obsessive-compulsive disorders, as well as reducing fatigue and increasing activity)[6].

Is it possible that neurosis will develop into schizophrenia?

In some complex cases, due to the vagueness of the primary symptoms, it is not possible to immediately make a correct diagnosis. Gradual manifestations of sluggish schizophrenia, at the initial stage of the disease, can be very similar to neurosis.

Neurosis and schizophrenia are completely different diseases. And therefore one cannot pass into the other.

After proper treatment, neuroses go away, while schizophrenia is characterized by a chronic nature. It cannot be said that neurosis turns into schizophrenia, one can only assume that the initial diagnosis was made incorrectly.

Sometimes schizophrenia is complicated by obsessive-compulsive disorder - obsessive-compulsive disorder, but signs of other pathologies may also be present.

Notes

1. ↑ 1 2 3 4 N. N. Ivanets, Yu. G. Tyulpin, V. V. Chirko, M. A. Kinkulkina.
   Psychiatry and narcology: textbook. - M.: GEOTAR-Media, 2006. - P. 473-474. — 832 p. — ISBN 5-9704-0197-8.
2. O'Connor K., Connor K. O., Nelson B., Walterfang M., Velakoulis D., Thompson A. (2009). "Pseudoneurotic schizophrenia revisited." The Australian and New Zealand journal of psychiatry 43
   (9): 873–876. DOI:10.1080/00048670903107658. PMID 19670061.
3. ↑ 1 2 V. M. Bleikher, I. V. Kruk.
   Neurosis-like schizophrenia // Explanatory dictionary of psychiatric terms. - MODEK, 1995. - ISBN 5-87224-067-8.
4. World Health Organization.
   Section V of the “International Statistical Classification of Diseases, Injuries and Causes of Death, 9th Revision”, adapted for use in the USSR. - M., 1983. - P. 29.
5. World Health Organization.
   Class V: Mental and behavioral disorders (F00-F99) (adapted for use in the Russian Federation). Part 1 // International classification of diseases (10th revision). - Rostov-on-Don: Phoenix, 1999. - P. 125. - ISBN 5-86727-005-8.
6. T. S. Syunyakov, E. S. Teleshova, S. A. Syunyakov, V. V. Koshelev, G. G. Neznamov.
   Features of the therapeutic action and effectiveness of rispolept consta in patients with pseudoneurotic schizophrenia (results of an open study) // Psychiatry and psychopharmacotherapy. - 2006. - No. 4. - ISSN 2075-1761.

The clinical picture that develops during a mental disorder

The majority of patients are teenagers and young adults, whose age ranges from 13 to 20 years. The syndromes of dysmorphomania and dysmorphophobia are pronounced in those suffering from pathology: the patient convinces himself and others of his own ugliness, and usually a specific part of the body is highlighted (arm, leg, nose, ear). The defect detected by the patient is usually imaginary, but in rare cases there may actually be a small flaw that is completely unnoticeable.

Another feature of patients with neurosis-like schizophrenia is that such people can get into philosophy and think for hours on the same topics. Frequent questions that people suffering from mental disorders like to discuss are the reasons for the existence of man on Earth, the meaning of the life of a particular individual and of all humanity.

Thoughts “about the eternal”, as a rule, remain just a set of proposals that do not imply specific actions. The patient does not pay any attention to outside criticism, preferring to delve deeper into reflection and write down ideas in a diary. It is usually impossible to understand a single line of what such a person writes.

Excessive anxiety, which is manic in nature, is another quirk of people diagnosed with neurosis-like schizophrenia (symptoms may be characteristic of other mental disorders). The instinct of self-preservation, natural fear for their life and health is characteristic of them in a perverted form; sometimes patients are afraid of even the most ordinary things. In order to somehow protect themselves, people suffering from schizophrenia perform small strange rituals. For example, they go to bed wearing different socks and a hat.

In addition, such people are often visited by hypochondria. This condition is characterized by a constant search for symptoms of a serious and incurable disease that no one has ever had before. The patient convinces himself that he is very sick, usually with a disease unknown to science, and will soon die. This behavior may also be typical for children with attention deficit disorder.

Literature

• Hoch P., Polatin P. (1949). "Pseudoneurotic forms of schizophrenia." The Psychiatric Quarterly 23
  (2): 248–276. PMID 18137714.
• Hoch PH, Cattell JP (1959). "The diagnosis of pseudoneurotic schizophrenia". The Psychiatric Quarterly 33
  (1): 17–43. DOI:10.1007/BF01659427. ISSN 0033-2720.
• Hoch PH, Cattell JP, Strahl MO, Pennes HH (1962). "The course and outcome of pseudoneurotic schizophrenia." The American Journal of Psychiatry 119
  : 106–115. DOI:10.1176/ajp.119.2.106. PMID 13907898.

Treatment

The course of therapy is individual in each case. It depends on which clinical manifestations come to the fore and which remain secondary. Our psychiatrist will select medications and dosages, taking into account the specific course of the disease. These are mainly antipsychotics, mild tranquilizers and antidepressants.

After eliminating phobias and obsessive states, the patient is supplemented with psychotherapy . Individual sessions with a doctor help the patient realize the groundlessness of his obsessions and fears, while group sessions help restore communication skills and establish contacts with those closest to him.

At the “Balance” clinic you can undergo treatment on an outpatient basis or in a hospital setting. For this we have all the necessary conditions - bright, comfortable rooms of various categories, polite and competent medical staff, experienced psychiatrists, modern equipment. If you cannot come to our clinic for a consultation with a specialist, use an online consultation or a doctor’s home call service. We work around the clock, so we will arrive at any time. Our clinic phone number: +7 (499) 495-45-03.

F23 Acute and transient psychotic disorders

A heterogeneous group of disorders characterized by the acute onset of psychotic symptoms, such as delusions, hallucinations and perceptual disturbances, and severe disruption of usual behavior. Acute onset refers to the rapidly increasing development (over two weeks or less) of a clearly defined abnormal clinical picture. There is no obvious organic cause for these disorders. Confusion and bewilderment are often noted, but disorientation in time, place and environment is not so persistent and severe that delirium of organic etiology can be diagnosed (F05.-). Full recovery usually occurs within a few months, often within a few weeks or even days. If these disorders become persistent, it will be necessary to change the classification rubric for this condition. The described disorder may (not always) be associated with acute stress, which refers to stressful situations that occurred one to two weeks before the onset of the disorder.

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Pseudoneurotic (neurosis-like) schizophrenia is one of the forms of schizophrenic deviations, distinguished by symptoms of psychopathology that are in many ways similar to the course of neurosis. The disease is manifested by fears, obsessive states (obsessions), depressive and hypochondriacal experiences, and depersonalization. In medicine, the term schizoneurosis is also used for it. The disease is included in the group of schizotypal personality disorders.

Forecasts

The disease has a favorable treatment prognosis. Most patients achieve a state of stable remission, which can last for years. Thanks to pharmacotherapy and psychotherapy, the patient gets rid of phobias, restores, as far as possible, mental functions, volitional and emotional spheres, establishes social connections, returns to society and the family. However, to prevent relapses and relapses, it is necessary to continue taking the medications and follow all the recommendations of the attending physician.

Symptoms of neurosis-like schizophrenia

At the very beginning of the formation of the disorder, signs characteristic of a neurotic disorder are revealed. Only an experienced and observant psychiatrist can identify their schizophrenic nature. Therefore, we insist on consultation at our mental health center if you suspect the presence of this disease.

The doctor pays attention to the following nuances:

• A neurotic person tries to hide his problems for a long time, recognizing and experiencing the manifestations of neurosis within himself.

• The schizophrenic denies his painful symptoms.
• Persons with neurosis are looking for ways to eliminate existing deviations.
• A patient with schizophrenia does not even think about the need for treatment.

The main symptoms of neurosis-like schizophrenia:

For what reasons does neurosis-like schizophrenia develop?

Experts do not have a consensus on the mechanism that causes the development of pseudoneurotic schizophrenia. The main factor is considered to be unfavorable

heredity.

But still, several more reasons for the development of this pathology can be identified:

• the presence of serious shocks experienced in childhood;
• developmental problems in the perinatal period;
• taking narcotic drugs;
• unfavorable environment in the family or at work;
• constant conflicts with the immediate environment;
• frequent stress.

Children whose parents are over 35 years of age are at risk, since a variety of complications can be attributed to the peculiarities of late pregnancy.

Neurosis-like schizophrenia in girls is often accompanied by a complex disease called anorexia in medicine. They are haunted by obsessions about their own ugliness and this gives impetus to the development of dystrophy.

Patients with schizoneurosis often blame their loved ones for personal problems. They gradually lose the ability to contact people around them. Therefore, drug treatment should be started as early as possible.

Differential diagnosis

When collecting all the necessary data, it is necessary to clearly understand whether we are talking about neurosis-like schizophrenia or neurosis.

To distinguish, the diagnostician uses the following criteria:

• 
  In 90% of cases, a client with a neurotic disorder is aware that he has an illness, although he tries not to seek help from a doctor for a long time.

• The schizophrenic ignores deviations and the need for medical assistance.
• Neurosis does not destroy a person’s personality and appears due to an identifiable cause.
• Schizoneurosis produces obvious changes in character and affects cognitive abilities. The clinical picture of the disorder develops without any obvious prerequisites.

Neurotic manifestations can be completely cured if the treatment process is properly organized and carried out. Neurosis-like schizophrenia, even in the case of successful therapy, leaves an imprint on personality traits. The disease may recur.