Fur-like schizophrenia: symptoms, course of the disease, treatment and prognosis

The variety of forms and variants of the course of schizophrenia forces psychiatrists from time to time to revise the classification of this disease. Before the appearance of the tenth edition of the International Classification of Diseases, Russian psychiatrists identified four types of schizophrenia: continuous, coat-like (paroxysmal-progressive), sluggish and periodic (recurrent).

Today, the last two types of illness are considered not as schizophrenia, but as mental disorders of the schizophrenia spectrum (sluggish - as schizotypal, and recurrent - as schizoaffective personality disorder). Thus, at present, according to ICD-10, there are two main variants of the course of schizophrenia: coat-like and continuous.

The essence of the disease

This type of disease is also called paroxysmal-progressive schizophrenia. It is characterized by alternating acute attacks with light intervals. The consequences of the attacks may not be observed, and in some cases some personality changes are noticeable.

With this disease, there are also this type of exacerbation, which are called fur coats, hence the name of the pathology. They necessarily have an impact on the human psyche, causing a certain “shift”. The result is the appearance of a pronounced mental defect.

Clinical manifestations of fur coat-like schizophrenia

All types of schizophrenia are characterized by negative personality changes; with this type of disease they begin to appear gradually, increasing after each attack. Fur-like schizophrenia may initially have the following symptoms:

• Obsessive ideas appear.
• The patient begins to consider all his actions as if from the outside; he believes that he cannot manage and control them.
• Paranoid ideas arise, which lead to excessive suspicion, a person looks for his enemies everywhere, and delusions of grandeur appear.

Subsequent symptoms arise as qualitatively new manifestations of a mental disorder. Attacks of this disease have a different clinical picture. Most often this is:

• Depressive-hallucinatory states.
• Acute paranoid.
• Catatonic-depressive.
• Depressive-obsessive states.

This is only a small part; in fact, the manifestations of the disease are much wider.

Fur-like schizophrenia may have varying degrees of depth of developing mental defects. They differ not only in variations, but also in the degree of progression.

In some cases, this form of the disease is close to malignant and can result in schizophrenic dementia. In other situations, progressive tendencies are weakly expressed, and the disease proceeds in a sluggish form, personality defects are insignificant.

Quite often it happens when fur coat-like schizophrenia occupies an intermediate position between two variants of the course. If you ask a doctor about how often such patients have attacks, he will answer that almost a third of all patients with this disease can suffer an exacerbation only once, while in others the pathology reminds itself once every few years.

Personality changes do not directly depend on the number of attacks. Even numerous exacerbations may not result in pronounced manifestations of mental defects.

Continuous flow

In the early stages of schizophrenia, predominantly productive symptoms are observed. First, neurosis-like disorders occur, then delusions and hallucinations are added to the clinical picture of the disease. Subsequently, catatonic disorders may develop. Over time, symptoms progress steadily. Remissions are possible only with appropriate treatment. In the later stages of the disease, negative manifestations predominate: emotional impoverishment, schizis (separation of mental and emotional activity) and volitional disorders.

The severity of certain manifestations at different stages of schizophrenia depends on the form of the disease. The course of schizophrenia that begins in childhood and adolescence is particularly malignant. In this case, pronounced negative symptoms appear very early, and after 1-4 years a pronounced personality defect is formed.

Schizoaffective form of schizophrenia

In anticipation of the development of this form of pathology, periodic mood changes may be observed, which gradually appear more often and become more pronounced. Psychotic symptoms, mania and depression develop.

In the intervals between such outbursts, obsessions, hypochondriacal and hysterical disorders may appear. If we talk about pronounced personality changes, then fur coat-like schizophrenia of this form, as a rule, does not have any. The mental defect is more noticeable when, during exacerbations, psychotic symptoms are observed rather than mood disorders.

Catatonic syndrome

Main article: Catatonic syndrome

Catatonic syndrome

- psychopathological syndrome (group of syndromes), the main clinical manifestation of which is movement disorders. Catatonia was first described by Kahlbaum (1874) as an independent mental illness; subsequently, Kraepelin and Bleuler classified it as schizophrenia[13]. The structure of the catatonic syndrome includes catatonic excitation and catatonic stupor.

Currently, it is becoming increasingly clear that schizophrenia is only one, far from the most common cause of catatonic syndrome. Other causes of catatonia include affective and some other mental disorders[13][14][15][6][16], somatic[13][14][15] and neurological diseases[15][16], taking certain medications and some drugs[6].

A much more common cause than schizophrenia is affective disorders[13][6][17] (depression and mania[13]).

Paroxysmal-progressive form

The vivid development of the clinical picture of this form is preceded by a visible change in the patient’s character. The circle of interests becomes narrower, emotional reactions to surrounding events become flattened. The person becomes suspicious and may express paranoid ideas.

The disease can be continuous or paroxysmal. In the first scenario, in the intervals between attacks, the patient continues to have delusions and mental disorders. If the pathology occurs in attacks, then during the period of remission there are practically no psychotic symptoms, and during exacerbations, hallucinations and delusions can be observed.

Attacks can have varying durations, it can be a month, and in some patients they drag on for several years. Throughout life there can be three or more such periods. During exacerbations, symptoms are determined not only by the form of the disease, but also by the stage of its development.

The following can be observed:

• Severe hallucinations.
• Interpretive nonsense.
• Kandinsky-Clerambault syndrome.
• Paraphrenia.

Even during remission of the disease, residual mental disorders can be observed in the form of fragmentary hallucinations and delusional ideas. Patients do not tend to have a critical attitude towards attacks.

This form of schizophrenia is characterized by more or less pronounced personality disorders, ranging from minor changes in character to the complete inability of a person to exist in society.

What is remission in schizophrenia?

What previously drove a person crazy is now perceived as absolutely normal by him

It is necessary to distinguish remission from recovery, because when such an improvement occurs, the patient is not considered healthy at all. Schizophrenia is a chronic disease characterized by both periods of exacerbation and temporary improvements in the patient’s condition.

If a satisfactory mental state is observed in the patient for more than six months, then this allows us to talk about the transition of the disease to the latent phase of its development. At this stage, the symptoms of the disease are mild or completely absent. The patient can behave absolutely calmly, and his reaction to external stimuli is regarded as adequate. At the same time, in the calm phase the patient may show lethargy, and his activity decreases.

The duration of remission is determined by the effectiveness of the chosen treatment methods. Provided that drug therapy is correctly selected, the patient experiences a lasting improvement in well-being, especially after the completion of the first phase of the disease.

Despite the fact that during the period of remission, patients do not have any manifestations of the disease, they should continue to take medications, which will eliminate the possibility of developing psychoses and exacerbations of the disease.

Malignant form of the disease

Unfortunately, quite often this form of this terrible disease develops in teenage children. How does fur coat-like schizophrenia occur in a teenager? The medical history, as a rule, contains information about exacerbations that can be observed for a year or more. At this time, pronounced psychotic symptoms occur. During life, there may be 3 or 4 such exacerbations, the duration of remission is gradually reduced, and the disease can acquire a continuous course.

The manifestations of this form of the disease are sometimes quite diverse and variable. Various symptoms may appear, ranging from catatonia to senesthopathy. During the period between attacks, a pronounced mental defect remains.

Clinical picture

There may be complete indifference to the outside world

With fur-like schizophrenia, the symptoms can be anything, and often change from attack to attack. The fur-like form of schizophrenia can be any: simple, catatonic, paranoid, etc. This disease is characterized by positive and negative symptoms of schizophrenia.

A feature of this course of the disease is the spontaneous onset of the attack.

Positive symptoms include:

• manic syndrome;
• hallucinations;
• rave;
• violation of self-awareness;
• obsessive thoughts and ideas.

In other words, these are productive symptoms, indicating incorrect, but active, functioning of the psyche and brain. Such symptoms can intensify over time, leading to complete destruction of the personality, forming the so-called schizophrenic defect. Despite the severity of the disease, such symptoms make it possible to accurately diagnose schizophrenia.

Negative symptoms indicate a decrease in mental activity and a slowdown in nervous activity. These include:

• deterioration in the ability to experience emotions;
• decreased affect;
• apathy and anhedonia;
• speech disorders;
• muscle hypotonicity;
• decreased will.

If positive symptoms are quite effectively eliminated with special drugs, the presence of progressive negative symptoms greatly complicates treatment, since the standard treatment regimen can lead to a worsening of the disease.

In fur-like schizophrenia, it is the positive symptoms that dominate. On the one hand, this has obvious manifestations, so the disease cannot be ignored, but on the other hand, it allows the effective use of neuroleptics or antipsychotics. However, such symptoms make the patient potentially dangerous both to others and to himself.

An example of manifestation of fur coat-like schizophrenia

The disease can last for several years

To better understand how this disease manifests itself, we should consider an example of its manifestation.

The onset of the attack practically goes unnoticed by the patient himself. It’s just that at some point he begins to feel vague anxiety or growing anxiety. Then an obsession with a touch of delirium appears, for example, the patient decides to invent something worthwhile, without having the necessary skills and abilities. At first, the patient devotes all his free time to this idea, then gives up his usual responsibilities (for example, work) and lifestyle in order to devote more time to this activity. After some more time, the patient loses his appetite, reduces the duration of sleep, just to be able to engage in his “invention”.

After some time, the symptoms increase and paranoia joins them. The patient thinks that his “invention” has attracted the interest of a neighbor, intelligence agents, or even aliens. Then hallucinations join the symptoms. Most often, these are auditory hallucinations. The patient hears “voices” that either help him in his “invention” or threaten him with persecution and other punishments.

Such an attack can last from several weeks to many months. On average, the attack lasts for 2-3 months, but there are cases when the patient remained in this state for a year or more.

Further developments depend on many factors. As a rule, after some time, relatives and friends notice strangeness in a person’s behavior and go to a psychiatric clinic. The patient is placed in a hospital, takes drug therapy, which after some time gives a positive result and the attack is successfully stopped.

The main feature of fur coat-like schizophrenia is the almost complete preservation of personality after the attack is stopped. In other words, “having come to,” the patient remains the same person as before the onset of the disease. Of course, there are exceptions, so it cannot be said that the fur-like course of the disease does not affect personality and character at all.

It should be noted that the fur-like course of the disease is the most common form of schizophrenia and is observed in half of the cases of this disease.

Periodic or circular form

Characterized by single depressive and manic attacks. It happens that double attacks are observed, that is, one type of course replaces another.

If there is schizophrenia, the fur-like course in this form resembles depressive psychosis. The very first attacks are practically indistinguishable from it. Subsequent ones already occur with the following symptoms:

• Ideas of persecution appear.
• Fantastic nonsense.
• Catatonic disorders.
• A cheerful mood may be replaced by stupid behavior and foolishness, and the desire for work may be replaced by disinhibition.

Therapy for the disease may vary depending on the form of the pathology, so any decision on this matter should be made only by a doctor.

Drug treatment

Treatment during an attack

A) Antipsychotics (Risperidone, Olanzanpine) - stop hallucinosis and delusions, return speech abilities and mental functions to relative normality, thus relieving the main symptoms of the attack. The latest generation of drugs (atypical antipsychotics - Risperidone, Olanzanpine) are mostly free of severe side effects.

Proven old drugs (traditional antipsychotics - haloperidol and derivatives) are also used, but their use is somewhat limited due to the severity of undesirable effects; positive aspects include their rapid effect on patients.

B) Anxiolytics (diazepam) are used at the stage of reducing anxiety and the level of motor overexcitation; the antipsychotic chlorpromazine performs the same functions. After relief of symptoms, medications are discontinued. As a rule, this happens a few days after the appointment.

C) Antidepressants (Amitriptyline) and mood stabilizers (valproic acid) neutralize fluctuations in the emotional sphere and are also used in subsequent stages.

Stabilization

Begins after eliminating the main complaints, therapy is aimed at minimizing residual effects. The duration of this stage is up to a year.

Antipsychotics continue to be taken; medications and dosages require an individual approach. Preference is given to long-acting options that require dosing once a week. This scheme leads to a high level of compliance (adherence to treatment) among patients and reduces the likelihood of skipping medication.

Prescription of conventional antipsychotics, which have a more extensive effect on psychotic symptoms, is practiced, but their use is limited due to the severity of side effects.

Maintenance therapy

Duration ranges from several years to lifelong appointment. The goal is to prevent relapses. Low doses of antipsychotics are prescribed, depending on the patient's sensitivity to them.

In parallel, other groups of medications can be used, the function of which is to normalize other areas of mental activity (antidepressants, psychostimulants).

Long-term use of drugs in some cases leads to the appearance of drug-induced parkinsonism, therefore, along with classical drugs, antiparkinsonian drugs (Cyclodol) are prescribed.

Causes of development of fur coat-like schizophrenia

At present, it is still not fully understood what reasons lead to the development of fur coat-like schizophrenia. The pathological genesis is not clear, but developmental factors are believed to include:

1. Genetic features.
2. Features of the human constitution.
3. Belonging to a certain gender and age.

It is difficult to recognize the main cause of schizophrenia, but most often it is:

• Anomalies in brain development.
• Hereditary predisposition.
• Exhaustion of the female body during pregnancy.

Whatever factor causes the development of this pathology, therapy should always be carried out. A competent specialist will help improve the patient’s quality of life and return him to normal existence as much as possible.

Causes

Among the causes of schizophrenia, a genetic predisposition cannot be excluded. The disease can be transmitted not only from parents, but also from other relatives.

The maximum risk of pathology occurs when both parents have mental disorders. Numerous factors associated with a negative impact on a woman’s psycho-emotional state at different periods of her life can provoke an exacerbation of schizophrenia.

The following factors can provoke schizophrenia in women:

• consequences of regular stressful situations and traumatic factors;
• brain damage of a traumatic or organic nature;
• tendency to depression (including postpartum depression);
• psychotraumatic situations that arose in childhood;
• consequences of viral or infectious diseases (especially with brain damage);
• negative consequences of hormonal changes in the body (during adolescence or pregnancy);
• prolonged and uncontrolled use of psychotropic drugs;
• neurotic personality and the presence of complexes;
• concomitant mental disorders (including phobias);
• consequences of abuse of bad habits.

Symptoms of the disease

The more frequent attacks of schizophrenia occur, the more noticeable endogenization becomes. The patient's condition is aggravated by the following conditions:

• sadness;
• motor retardation;
• ideas of guilt.

If adequate therapy is not started at this stage, the depression worsens, the person develops illusions and the desire to attribute his thoughts to others. In manic states, expansive delirium predominates:

• transformations;
• greatness;
• invention.

Exacerbations can last up to three years; negative symptoms are complicated by emotional decline, including autism. But it should be noted that gross mental defects may not manifest themselves. In some cases, against the background of paranoid changes, affective-delusional attacks develop. Many patients with fur coat-like schizophrenia have the following symptoms:

• hallucinations;
• delirium of poisoning, intoxication;
• depressive states that are aggravated by the idea of ​​persecution.

Between attacks, disorders may be present in a reduced form; mental changes in personality gradually become more noticeable. If the disease is not treated, it can become continuous.

If we mean childhood fur-like schizophrenia, the medical history of such patients contains information that children become uninitiative, constantly irritated, and alienated. They become opposed to others, and their mental activity decreases significantly. Hallucinations are most often visual, and instead of delusional ideas, delusional fantasies appear. Such children often show dissatisfaction, they are capricious, and motor disinhibition appears when their mood rises.

How does a schizophrenia attack develop?

Most often, attacks in this form of the disease follow the same pattern:

1. The initial stage of the disease is characterized by emotional disturbances. Periods of high spirits are replaced by indifference and a negative attitude towards everything around you.
2. The next stage is accompanied by delirium. It seems to the patient that he is a participant in the film, and there are actors around him who direct his actions. He also believes that the thoughts do not belong to him, others put them into his head.
3. As the disease progresses, it becomes complicated by antagonistic delusions. The patient divides all people into two opposing camps. Delusional ideas and delusions of grandeur develop.
4. The peak of pathology is manifested by catanonic disorders. The patient may not respond to comments at all and freezes in one position for a long time. In such cases, a clouding of consciousness occurs, the person begins to see fantastic visions that do not correspond to reality.
5. When a regressive state occurs, symptoms of emotional disorders reappear.

It should be noted that attacks do not always occur in this order. Development may end at one of the stages, while others will appear in short periods of time. The duration of the attack can range from several days to several months.

Classification and diagnostic criteria

ICD-9

According to the International Statistical Classification of Diseases, Injuries and Causes of Death, 9th revision (ICD-9), adapted for use in the USSR, the catatonic type of schizophrenia had code 295.2295.2. Clinical variants of catatonia: 295.21295.21 - catatonia with delusions and hallucinations as a variant of malignant schizophrenia, 295.22295.22 - lucid catatonia as a variant of malignant schizophrenia, 295.23295.23 - lucid catatonia as a variant of fur-like schizophrenia, 295.24295.24 — oneiric catatonia as a variant of fur coat-like schizophrenia , 295.25295.25 - oneiric catatonia as a variant of periodic schizophrenia, 295.29295.29 - unspecified catatonia[2].

Malignant schizophrenia includes cases when massive negative disorders rapidly and steadily increase, which leads to a pronounced schizophrenic defect [2].

The main feature of the catatonic type of schizophrenia in ICD-9 is pronounced psychomotor disorders (polar in nature: from automatic submission to negativism, from hyperkinesis to stupor)[2]. Characterized by catatonia, catalepsy, waxy flexibility, catatonic agitation, catatonic stupor, catatonic agitation[2]. It is noted that the appearance of affective disorders (depressive or hypomanic) is possible[2].

ICD-10

This section is transcribed from Schizophrenia. (edit | history)

Below are the official general criteria for paranoid, hebephrenic, catatonic and undifferentiated schizophrenia (F20.0-F20.3)[3]. According to ICD-10, to make a diagnosis, at least one of the following signs must be observed:

• (a) “Echo” of thoughts (the sound of one’s own thoughts), putting or taking away thoughts, openness of thoughts to others.
• (b) Delusions of mastery, influence, or passivity, distinctly relating to the body or limbs, thoughts, actions, or sensations; delusional perception.
• (c) Hallucinatory "voices" commenting or discussing the patient's behavior; other types of "voices" coming from different parts of the body.
• (d) Persistent delusions that are culturally inappropriate, absurd, impossible, and/or grandiose in content.

Or at least two of the following “lesser” symptoms must be observed:

• (e) Persistent hallucinations of any kind, if they occur daily for at least one month and are accompanied by delusions (which may be unstable and semi-formed) without a distinct affective content.
• (f) Neologisms, sperrungs (breaks in thinking), leading to discontinuity or inconsistency in speech.
• (g) Catatonic behavior such as agitation, rigidity or waxiness, negativism, mutism and stupor.
• (h) “Negative symptoms” (but not caused by depression or pharmacotherapy), usually leading to social withdrawal and decreased social performance; symptoms that can be expressed: apathy
• speech impoverishment or smoothness
• inadequacy of emotional reactions

(i) Reliable and consistent changes in the general quality of behavior, manifested by loss of interests, aimlessness, absorption in one’s own experiences, social alienation.

Diagnostic instructions
In this case, these symptoms should be observed for at least a month. Conditions that meet these criteria but last less than a month are classified as acute schizophrenia-like psychotic disorder (23.223.2 with an additional fourth character indicating the nature of the disorder), and if they subsequently continue for more than a month, the diagnosis is changed (recoded) to the corresponding form of schizophrenia[ 3].

When symptoms of schizophrenia develop together with severe symptoms of other disorders (affective: manic or depressive episodes, epileptic, other brain diseases, alcohol or drug intoxication or withdrawal syndrome), the diagnosis of schizophrenia is not made, and the appropriate diagnostic categories and codes are used. The diagnosis of schizophrenia is made if the case meets the criteria for a manic episode 30.- or a depressive episode (32.-), but the above general criteria are identified before

development of mood disorders[3].

Symptom (i) in the list above refers only to the diagnosis of “simple type of schizophrenia” (20.620.6), and a period of observation of symptoms by a psychiatrist of at least one year is required[3].

To diagnose catatonic schizophrenia according to ICD-10, it is necessary to meet the general criteria for schizophrenia, as well as the presence of one or more of the following symptoms[4][5]:

• stupor or mutism
• negativism
• waxy flexibility (pathologically long-term holding of a given position)
• freezing (taking and holding strange and inappropriate poses)
• rigidity (maintaining a rigid posture in response to attempts to change it)
• excitement (apparently meaningless activity)
• stereotypies (performing stereotypical movements)
• automatic obedience (automatic execution of directions and instructions) and perseveration

Symptoms must be observed for at least 2 weeks.

Includes: lucid and oneiric catatonia, catatonic agitation, catatonic stupor, schizophrenic catalepsy, schizophrenic catatonia, schizophrenic waxy flexibility[4][5].

Flow options

Types of disease:

• continuous F20.20
• episodic with increasing defect F20.21
• episodic with stable defect F20.22
• episodic relapsing F20.23

Incomplete remission is indicated by code F20.24, complete remission F20.25.

Differential diagnosis

Catatonic disorders due to affective disorders (mania, depression), hysteria, temporal lobe epilepsy, metabolic disorders (hyponatremia, Wilson's disease, Tay-Sachs disease), cocaine, ecstasy, ciprofloxacin, withdrawal of the antipsychotic clozapine and some other diseases and conditions should be excluded [6 ].

According to ICD-10, if a patient with severe depression is in a stupor, the diagnosis is “major depressive episode with psychotic symptoms” (32.332.3), if a patient with mania is in a stupor, “mania with psychotic symptoms” (30.230.2 ). Catatonia caused by a physical illness is diagnosed as “organic catatonic disorder” (06.106.1)[6].

When determining mutism, selective mutism in schizoid personality disorder should be excluded.

DSM

The American Diagnostic and Statistical Manual of Mental Disorders, 2nd edition (DSM-II) distinguished two subtypes of catatonic schizophrenia: “excited” (code 295.23) and “withdrawn” (code 295.24). The first is characterized by excessive motor activity and excitement, and the second by generalized inhibition, which manifests itself in stupor, negativism, mutism or waxy flexibility [7].

In the 3rd revised edition (DSM-III-R, code 295.2x) there was a requirement for the dominance of the following signs in the clinical picture: catatonic stupor, catatonic negativism, catatonic rigidity, catatonic agitation, catatonic posing [8].

The 4th edition (DSM-IV-TR) also lists the “catatonic type of schizophrenia” (295.20). To make this diagnosis, dominance in the clinical picture of at least two of the following criteria is necessary [9]:

• motor immobility, as evidenced by catalepsy (including waxy flexibility) or stupor;
• features of voluntary movements, characterized by posing (voluntary adoption of inappropriate or bizarre poses), stereotypical movements, conspicuous grimacing and mannerisms;
• extreme negativism (unreasonable resistance to all instructions or staying in a rigid position, with resistance to all attempts to change it) or mutism;
• excessive motor activity (purposeless and not under the influence of external stimuli);
• echopraxia and echolalia.

The latest edition of DSM-5 does not include types of schizophrenia[10][11].

Features of schizophrenia

If we take into account the many studies conducted, we can conclude that in the majority of patients who suffer from schizophrenia, even periods of remission are accompanied by chronic disorders that gradually develop. The degree of the disease and the depth of mental damage may vary.

A feature of the disease is mood swings, which are most often observed before the development of the first attack. Over time, such changes become more noticeable, the patient may fall into severe depression, mania and psychotic symptoms appear.

In the period between attacks, a sick person is characterized by hysterics and obsession. If we compare this type of schizophrenia with others, we can note that changes in the psyche are most often minor.

Establishing diagnosis

In identifying pathology, the timeliness of seeking medical help and the doctor’s competence are of great importance. A psychiatrist conducts and interprets diagnostic measures. The survey includes the following types of research:

1. A personal conversation between a doctor and a patient allows the doctor to assess the adequacy of a person’s judgments about the world and people around him, and to identify changes in the emotional and cognitive sphere. The psychiatrist also talks with relatives, since from them it is possible to get a complete picture of changes in a person’s psyche during the course of the disease.
2. The fact of drug or alcohol use is established, as well as a history of traumatic brain injury, infectious or tumor damage to the brain.
3. When conducting an external examination during a dialogue, a person’s motor activity is assessed. Catatonia is identified by pretentious postures that persist for a long period of time.
4. An objective assessment of the emotional sphere and cognitive skills is carried out using special psychological tests. The doctor individually selects testing methods depending on the clinical picture.
5. To assess the general condition of the body and identify concomitant diseases, clinical examination methods are carried out: clinical and biochemical blood tests, general urinalysis, electrocardiogram, etc.
6. To carry out differential diagnosis with organic brain damage, patients are advised to perform magnetic resonance imaging (MRI). MRI allows you to obtain a three-dimensional image of the central nervous system and identify the presence of pathological foci in it.

Detection of fur coat-like schizophrenia requires differential diagnosis with other types of schizophrenia, bipolar affective disorder, psychosis due to drug addiction or alcohol abuse and other conditions. In this regard, only a psychiatrist with the necessary knowledge and skills should interpret the data obtained as a result of the examination.

Treatment of the disease

We found out what fur coat-like schizophrenia is. The symptoms and course of the disease were also examined. It's time to stop treatment. Previously, it was believed that such a pathology is practically untreatable, but given the current level of development of medicine, it can be argued that it is now quite possible to achieve long-term remission and improve the patient’s quality of life.

The basis of therapy is the use of antipsychotics. They eliminate not only the signs of psychosis, but also the characteristic clinical manifestations of the disease.

Most often, doctors prefer monotherapy, that is, the use of one drug, usually of a new generation. This may include:

• "Solian."
• "Serokvyal."
• "Rispolept."

These medications slow down the progression of symptoms and prevent the appearance of hallucinations and delusions. A significant disadvantage of such drugs is their high cost, and treatment must be carried out long-term and systematically.

The types of fur coat-like schizophrenia are different, so the choice of drugs is also not the same. For example, in the paranoid form, the following drugs are preferred:

• "Triftazine"
• "Rispolept."
• "Azaleptin".

Treatment of the malignant form is usually accompanied by:

• "Aminazina."
• "Clopixol".
• "Rispolepta."

In the presence of mild forms, Truxal, Sonapax, and Neuleptil are prescribed.

Relatives of the patient must understand that treatment of fur-like schizophrenia should be carried out only by a specialist, and it is unacceptable to purchase medications at the pharmacy on their own - this can only worsen the person’s condition.

Not only drugs are important in the treatment of schizophrenia, psychotherapy is also required. It is important that the patient is supported by doctors and relatives: irritability and skepticism only lead to aggressiveness and detachment. Only with complex therapy will fur-like schizophrenia have a favorable prognosis.

Treatment can be carried out not only in a hospital setting, it all depends on the degree of the disease and the patient’s condition. If the patient does not pose a danger to himself or others, therapy is possible at home.

Forecast

Despite a fairly long history of the disease, the hebephrenic form of schizophrenia remains an incurable disease in which it is extremely difficult to achieve sustainable remission. The prognosis for hebephrenic schizophrenia in the vast majority of cases is unfavorable, since despite supportive therapy the disease often worsens, leading to irreversible personality changes and pathological disturbances in thinking. Patients with this diagnosis are considered disabled.

The negative prognosis and progression of the disease are largely associated with patients’ refusal to take medications after discharge from the hospital. To increase the chances of long-term remission, you must strictly adhere to the doctor’s recommendations, attend psychotherapy sessions, take prescribed medications and avoid stress.

Which doctor does the therapy?

A neurologist and a psychiatrist can help overcome this disease. It is best if these two specialists work together. The doctors' task is to:

1. Study how pathology manifests itself during attacks and between them.
2. Analyze the patient's life history.
3. Talk to the patient's loved ones.

Only after the diagnosis is confirmed and the form of the disease is determined, treatment tactics are chosen.

With the modern level of development of medicine, even the most severe mental disorders are treatable. It may not be a 100% recovery, but the patient’s quality of life can improve significantly, and remissions will have a longer period. If you have the slightest suspicion of mental pathology, be sure to visit a specialist; this is the only way to prevent the disease from worsening.

Literature

• Akopova I. L.
  Typology of oneiric catatonia. - Issue 11. - Journal neuropath and psychiatrist., 1965.
• Kerbikov O. V.
  Catatonic syndromes // Acute schizophrenia. - M.: Medgiz, 1949.
• Pivovarova V.L.
  About secondary catatonia. - M.: Proceedings of the All-Union Scientific and Practical Conference, dedicated. 100th anniversary of the birth of S. S. Korsakov., 1955.
• Serbsky V.P.
  Forms of mental disorder described under the name of catatonia. - M., 1890.